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Sample records for bladder outflow obstruction

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

    PubMed

    Thiruchelvam, Nikesh

    2014-04-01

    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.

  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. Beta adrenergic modulation of spontaneous microcontractions and electrical field-stimulated contractions in isolated strips of rat urinary bladder from normal animals and animals with partial bladder outflow obstruction.

    PubMed

    Gillespie, J I; Rouget, C; Palea, S; Granato, C; Korstanje, C

    2015-07-01

    Spontaneous microcontractions and electrical field stimulation (EFS)-evoked contractions in isolated rat bladder strips from normal and from 6 weeks partial bladder outflow obstruction (pBOO) animals were studied to identify the potential site of action for the β3-adrenoceptor (AR) agonist mirabegron in detrusor overactivity in rats. For this, effects of the β-AR agonist isoprenaline and mirabegron were tested in presence or absence of selective antagonists for β-AR subtypes, namely CGP-20712A for β1-AR, ICI-118,551 for β2-AR, and L-748,337 for β3-AR. In detrusor strips from both normal and obstructed animals, EFS-induced contractions were weakly affected by isoprenaline and even less so by mirabegron. In contrast, microcontraction activity was more potently reduced by isoprenaline (pIC50 7.3; Emax ±85 %), whereas mirabegron showed a small effect. In pBOO strips, concentration response curves for isoprenaline and mirabegron at inhibition of EFS and spontaneous microcontractions were similar to those in normal strips. Isoprenaline-induced inhibition of microcontractions and EFS was antagonized by the β1-AR antagonist, but not by the β2- and β3-AR antagonists. In the context of β3-AR-mediated bladder functions for mirabegron in other experiments, the current data question a role for effects at spontaneous microcontractions, or neurogenic detrusor stimulation in the mode of action for mirabegron in vivo, since functional bladder effects for mirabegron are reported to occur at much lower concentrations.

  4. Risk of erectile dysfunction and retrograde ejaculation associated with thulium laser vaporesection of the prostate for bladder outflow obstruction: a retrospective study.

    PubMed

    Yee, Carol Ling Sze; Pal, Raj P; Batchelder, Andrew; Khan, Masood A

    2012-01-01

    The aim of this study was to determine the incidence of erectile dysfunction and retrograde ejaculation following thulium:yttrium-aluminium-garnet (Tm:YAG) laser prostate vaporesection (ThuVaRP). Between January 2009 and June 2010, 113 consecutive patients underwent ThuVaRP for bladder outflow obstruction. Of these, 54 (48%) were included in the study as they were able to maintain an erection for sexual intercourse prior to undergoing ThuVaRP. All patients had benign pathology and had not undergone previous bladder neck surgery. The incidence of erectile dysfunction and retrograde ejaculation was reported at a mean follow-up period of 12 months post-operatively. The mean patient age was 71 years (range 46-90). The mean follow-up period was 12 months (range 4-21). 11 (20%) patients experienced worsening erectile function with 3 (6%) noticing an improvement. A total of 30 patients (56%) experienced some degree of retrograde ejaculation. 4 patients (7%) noticed an improvement in their ejaculation. Retrograde ejaculation was more common in patients with an indwelling catheter in situ for refractory urinary retention (43 vs. 17%, p = 0.04) and in diabetic patients (27 vs. 4%, p = 0.03). There was an increased trend of erectile dysfunction in men aged ≥70 years, with hypertension and with hypercholesterolaemia, but this was not significant. Our retrospective study has demonstrated that the overall risk of erectile dysfunction and retrograde ejaculation associated with ThuVaRP is 20 and 56%, respectively. Copyright © 2012 S. Karger AG, Basel.

  5. Bladder Outlet Obstruction: Causes in Men?

    MedlinePlus

    ... is the most common cause of bladder outlet obstruction in men Scarring of the urinary channel (urethra) or bladder neck, as a result of injury or surgery Use of certain medications, including antihistamines, decongestants ... of bladder outlet obstruction is important to prevent serious problems caused by ...

  6. Left ventricular outflow obstruction and necrotizing enterocolitis

    SciTech Connect

    Allen, H.A.; Haney, P.J.

    1984-02-01

    Two neonates had unusually rapid development of necrotizing enterocolitis within 24 hours of birth. Both patients had decreased systemic perfusion secondary to aortic atresia. Onset of either clinical or radiographic manifestations of necrotizing enterocolitis in the first day of life should alert one to the possible presence of severe left ventricular outflow obstruction.

  7. Murine bladder wall biomechanics following partial bladder obstruction.

    PubMed

    Chen, Joseph; Drzewiecki, Beth A; Merryman, W David; Pope, John C

    2013-10-18

    Evaluation of bladder wall mechanical behavior is important in understanding the functional changes that occur in response to pathologic processes such as partial bladder outlet obstruction (pBOO). In the murine model, the traditional approach of cystometry to describe bladder compliance can prove difficult secondary to small bladder capacity and surgical exposure of the bladder. Here, we explore an alternative technique to characterize murine mechanical properties by applying biaxial mechanical stretch to murine bladders that had undergone pBOO. 5-6 week old female C57/Bl6 mice were ovariectomized and subjected to pBOO via an open surgical urethral ligation and sacrificed after 4 weeks (n=12). Age matched controls (n=6) were also analyzed. Bladders were separated based on phenotype of fibrotic (n=6) or distended (n=6) at the time of harvest. Biaxial testing was performed in modified Kreb's solution at 37°C. Tissue was preconditioned to 10 cycles and mechanical response was evaluated by comparing axial strain at 50kPa. The normal murine bladders exhibited anisotropy and were stiffer in the longitudinal direction. All mice showed a loss of anisotropy after 4 weeks of pBOO. The two phenotypes observed after pBOO, fibrotic and distended, exhibited less and more extensibility, respectively. These proof-of-principle data demonstrate that pBOO creates quantifiable changes in the mechanics of the murine bladder that can be effectively quantified with biaxial testing.

  8. Metastatic carcinoid tumor obstructing left ventricular outflow.

    PubMed

    Chrysant, George S; Horstmanshof, Douglas A; Guniganti, Uma M

    2011-01-01

    Cardiac tumors are rare and usually indicate metastatic disease. Characterizing a tumor and reaching an exact diagnosis can be difficult. Diagnosis has been aided greatly by advances in imaging, such as cardiovascular magnetic resonance with the use of gadolinium-pentetic acid. Carcinoid tumors are neuroendocrine neoplasms that are found most often in the intestinal tract, although they can also develop in the lung, stomach, or heart. Herein, we report the case of a 72-year-old woman with a history of intestinal carcinoid disease and presenting symptoms of dizziness, fatigue, and chest pain. We used cardiovascular magnetic resonance with gadolinium enhancement to identify a large mass obstructing left ventricular outflow. The histopathologic results of an endomyocardial biopsy confirmed that the mass was a left-sided metastatic carcinoid cardiac tumor. To our knowledge, we are reporting the 1st combined use of clinical evaluation, cardiovascular magnetic resonance, and histopathologic studies to reach such a diagnosis.

  9. Metastatic Carcinoid Tumor Obstructing Left Ventricular Outflow

    PubMed Central

    Chrysant, George S.; Horstmanshof, Douglas A.; Guniganti, Uma M.

    2011-01-01

    Cardiac tumors are rare and usually indicate metastatic disease. Characterizing a tumor and reaching an exact diagnosis can be difficult. Diagnosis has been aided greatly by advances in imaging, such as cardiovascular magnetic resonance with the use of gadolinium-pentetic acid. Carcinoid tumors are neuroendocrine neoplasms that are found most often in the intestinal tract, although they can also develop in the lung, stomach, or heart. Herein, we report the case of a 72-year-old woman with a history of intestinal carcinoid disease and presenting symptoms of dizziness, fatigue, and chest pain. We used cardiovascular magnetic resonance with gadolinium enhancement to identify a large mass obstructing left ventricular outflow. The histopathologic results of an endomyocardial biopsy confirmed that the mass was a left-sided metastatic carcinoid cardiac tumor. To our knowledge, we are reporting the 1st combined use of clinical evaluation, cardiovascular magnetic resonance, and histopathologic studies to reach such a diagnosis. PMID:21720473

  10. Urinary bladder marsupialization for treatment of obstructive urolithiasis in male goats.

    PubMed

    May, K A; Moll, H D; Wallace, L M; Pleasant, R S; Howard, R D

    1998-01-01

    To describe a surgical procedure for urinary bladder marsupialization and to report the results obtained from its use in the treatment of obstructive urolithiasis in male goats. Retrospective evaluation. Male goats with obstructive urolithiasis. Medical records of male goats that had urinary bladder marsupialization for the treatment of obstructive urolithiasis were reviewed. Data retrieved from the medical records included signalment, postoperative treatment, duration of hospitalization, and short-term and long-term complications. Median values for measured variables were calculated. A total of 18 of 19 goats survived. Urinary flow was re-established in all 19 goats at the conclusion of surgery. Short-term postoperative complications (bladder mucosal prolapse and death) were observed in 2 goats. Long-term postoperative complications (cystitis and fibrotic stomal closure) occurred in 2 animals. Median duration of hospitalization was 4 days. At the time of follow-up, mild urine scald was reported for all goats. Clinical signs of upper urinary tract disease or obstruction were not reported. A total of 15 of 17 owners were satisfied with the procedure. Urinary bladder marsupialization provided long-term resolution of urinary outflow obstruction in all goats with acceptable morbidity. Urinary bladder marsupialization is a procedure that provides a good prognosis for long-term resolution of obstructive urolithiasis in male goats.

  11. Distended Bladder Presenting with Altered Mental Status and Venous Obstruction

    PubMed Central

    Washco, Vaughan; Engel, Lee; Smith, David L.; McCarron, Ross

    2015-01-01

    Background New onset or acute worsening of bilateral lower extremity swelling is commonly caused by venous congestion from decompensated heart failure, pulmonary disease, liver dysfunction, or kidney insufficiency. A thromboembolic event, lymphatic obstruction, or even external compression of venous flow can also be the culprit. Case Report We report the case of an 83-year-old male with a history of myelodysplastic syndrome that progressed to acute myeloid leukemia, bipolar disorder, and benign prostatic hypertrophy. He presented with altered mental status and new onset lower extremity edema caused by acute bladder outflow obstruction. Computed tomography of the abdomen and pelvis showed the patient's distended bladder compressing bilateral external iliac veins. Conclusion Insertion of a Foley catheter resulted in several liters of urine output and marked improvement in his lower extremity edema and mental status a few hours later. Our extensive workup failed to reveal a cause of the patient's acute change in mental status, and we attributed it to a concept known as cystocerebral syndrome. PMID:25829883

  12. Primary bladder neck obstruction may be determined by postural imbalances.

    PubMed

    Camerota, Tommaso Ciro; Zago, Matteo; Pisu, Stefano; Ciprandi, Daniela; Sforza, Chiarella

    2016-12-01

    Primary bladder neck obstruction (PBNO) is a frequent under-investigated urological condition in which the bladder neck fails to open adequately during voiding. In the majority of cases no known etiological factor can be found. In this study we propose a new hypothesis to explain the origin of the disease in young male patients with no neurological disorders. We suggest a possible role of an unbalanced biomechanics of the pelvis on urethral sphincters activity and on functional bladder capacity. To support the proposed hypothesis, we present pilot gait analysis data of young male patients with primary bladder neck obstruction.

  13. Dynamic left ventricular outflow tract obstruction: underestimated cause of hypotension and hemodynamic instability

    PubMed Central

    2014-01-01

    Left ventricular outflow tract obstruction, which is typically associated with hypertrophic cardiomyopathy, is the third most frequent cause of unexplained hypotension. This underestimated problem may temporarily accompany various diseases (it is found in even <1% of patients with no tangible cardiac disease) and clinical situations (hypovolemia, general anesthesia). It is currently assumed that left ventricular outflow tract obstruction is a dynamic phenomenon, the occurrence of which requires the coexistence of predisposing anatomic factors and a physiological condition that induces it. The diagnosis of left ventricular outflow tract obstruction should entail immediate implementation of the therapy to eliminate the factors that can potentially intensify the obstruction. Echocardiography is the basic modality in the diagnosis and treatment of left ventricular outflow tract obstruction. This paper presents four patients in whom the immediate implementation of bedside echocardiography enabled a rapid diagnosis of left ventricular outflow tract obstruction and implementation of proper treatment. PMID:26674265

  14. Right ventricular outflow obstruction with intact ventricular septum in adults.

    PubMed Central

    Werner, A M; Darrell, J C; Pallegrini, R V; Woelfel, G F; Grant, K; Marrangoni, A G

    1997-01-01

    Cardiothoracic surgeons whose practice is limited to adults rarely see patients with right ventricular outflow obstruction and an intact ventricular septum. Of more than 10,000 open-heart procedures performed at our institution from 1983 to 1993 (in patients 18 to 75 years old), only 5 procedures were for correction of this problem. Both the pulmonary valve and the subvalvular area were abnormal in these 5 patients, and 4 of the 5 had subvalvular stenosis. The gradient across the right ventricular outflow tract was measured by cardiac catheterization before repair in all patients and averaged 118 mmHg. Various surgical approaches were used for repair. In the 2 patients whose pressures were measured postoperatively, the gradients were 25 mmHg and 45 mmHg, respectively. There were no operative deaths. At follow-up (range, 2 months to 5 years after surgery), all patients were in New York Heart Association functional class I and all had murmurs. Those who underwent echocardiography were found to have minimal gradients across the right ventricular outflow tract. Images PMID:9205983

  15. Urethral duplication with unusual cause of bladder outlet obstruction.

    PubMed

    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.

  16. 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

  17. Treatment of hepatic venous outflow obstruction after piggyback liver transplantation.

    PubMed

    Wang, Stephen L; Sze, Daniel Y; Busque, Stephan; Razavi, Mahmood K; Kee, Stephen T; Frisoli, Joan K; Dake, Michael D

    2005-07-01

    To evaluate retrospectively the endovascular management of hepatic venous outflow obstruction after piggyback orthotopic liver transplantation. The study was performed with the approval and under the guidelines of the institutional review board and complied with the Health Insurance Portability and Accountability Act. Informed consent from patients was not required by the institutional review board for this retrospective study. From 1995 to 2003, 13 patients (eight male, five female), including 12 adults and one adolescent (age range, 14-67 years; median age, 52 years), underwent endovascular treatment of hepatic venous outflow obstruction after piggyback orthotopic liver transplantation. Patients gave informed consent for all procedures. Eleven patients received whole livers, and two received living-related donor right liver lobes. Four underwent repeat piggyback orthotopic liver transplantation prior to intervention. Primary stent placement was performed in 12 patients. One patient refused primary stent placement and chose venoplasty alone, but required a stent 5 months later. Short balloon-expandable stents (mean diameter, 14.6 mm +/- 1.1 [standard deviation]) were used to minimize jailing of branch vessels and to resist recoil. Pre- and post-procedural pressure gradients were measured. Follow-up included venography, cross-sectional imaging, and laboratory tests. The Wilcoxon signed rank test or the sign test was performed to compare pre- and post-procedural pressure gradients, body weights, and laboratory values. Technical success (pressure gradient < or = 3 mm Hg) was achieved in 13 of 13 patients, and clinical success, in 12 of 13. Mean pre- and post-procedural pressure gradients were 13.0 mm Hg +/- 1.4 and 0.8 mm Hg +/- 0.3. Mean interval from transplantation to intervention was 348 days +/- 159. Mean follow-up was 678 days (range, 16-2880 days). Technical success did not result in clinical improvement in one patient. Biopsy demonstrated severe hepatic

  18. Comparison between prostate volume and intravesical prostatic protrusion in detecting bladder outlet obstruction due to benign prostatic hyperplasia.

    PubMed

    Hossain, A K M S; Alam, A K M K; Habib, A K M K; Rashid, M M; Rahman, H; Islam, A K M A; Jahan, M U

    2012-04-01

    The objectives of this study were to determine and compare the correlation of intravesical prostatic protrusion (IPP) and prostate volume (PV) with bladder outlet obstruction (BOO). This study was conducted in the department of urology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, between July 2009 to September 2010. Fifty benign prostatic hyperplasia (BPH) patients were included in the study. Their evaluation consisted of history along with International Prostate Symptoms Score (IPSS), digital rectal examination (DRE), transabdominal ultrasonography to measure prostate volume, intravesical prostatic protrusion & post voidal residual (PVR) urine and pressure-flow studies to detect bladder outflow obstruction (BOO). Statistical analysis included Unpaired 't' test, Chi-square test and Spearman's Rank correlation test. Receiver Operator Characteristic (ROC) curves were used to compare the correlation of PV and IPP with BOO. Mean prostate volume was significantly larger in bladder outlet obstructed patients (P<0.05). Mean IPP was significantly greater in obstructed patients (P<0.001). Area under ROC curve was 0.700 for PV and 0.821 for IPP. Prostate volume & intravesical prostatic protrusion measured through transabdominal ultrasonography are noninvasive and accessible method that significantly correlates with bladder outlet obstruction in patients with benign prostatic hyperplasia and the correlation of IPP is much more stronger than that of prostate volume.

  19. Treatment of primary bladder neck obstruction in women with transurethral resection of the bladder neck.

    PubMed

    Blaivas, Jerry G; Flisser, Adam J; Tash, Jennifer A

    2004-03-01

    We describe the presentation, clinical characteristics, treatment and followup of a series of women with primary bladder neck obstruction (PBNO). A patient data base was searched for women who underwent transurethral resection for bladder outlet obstruction diagnosed by videourodynamic study (VUDS) according to the Blaivas-Groutz nomogram for female bladder outlet obstruction between 1993 and 2002. A total of 37 women with obstruction were identified. Patients with neurogenic, traumatic, anatomical or iatrogenic causes of obstruction were excluded. Seven patients remained who had been diagnosed with PBNO, of whom all underwent transurethral bladder neck resection. Office records were reviewed for history, presentation, surgical treatment and clinical outcome. Seven patients were diagnosed with PBNO. Age was 39 to 81 years. Six of 7 patients presented with symptoms of obstruction, including a weak or intermittent stream and urinary hesitancy. These 6 patients had unremarkable physical examination findings with normal perianal sensation, anal sphincter tone and lower extremity reflexes. One patient presented with abdominal swelling, which on physical examination was found to be a markedly distended bladder containing more than 1000 cc urine. All patients had overt urethral obstruction on VUDS. In 6 of 7 patients obstruction was clearly at the vesical neck and in 1 the obstruction site was equivocal. Three patients were treated or had previously been treated pharmacologically with alpha-blockers. All patients were subsequently treated with intermittent self-catheterization. All patients then underwent transurethral bladder neck resection at the vesical neck and proximal urethra. Surgical specimens weighed 1 to 5 gm and showed urethral fragments or fibromuscular tissue without specific pathological findings. Followup was 1 to 10 years (median 3) and it included physical examination, uroflowmetry, post-void residual urine measurement and videourodynamic study. Six

  20. The bladder ran dry: bilateral ureteral obstruction.

    PubMed

    Schattner, Ami; Drahy, Yosef; Dubin, Ina

    2017-08-07

    A relatively young healthy man (barring obesity and distant gouty arthritis) was admitted with severe acute kidney injury (serum creatinine, 15.9 mg/dL) following acute gastroenteritis and occasional use of diclofenac. Abdominal ultrasound revealed mild left hydronephrosis due to staghorn stone and normal right kidney. Soon after, complete anuria necessitating haemodialysis developed without pain or evidence of infection. CT imaging revealed stones obstructing the right ureter. Following urological surgery, postobstructive diuresis developed and the serum creatinine came down to near normal. The stones were identified as uric acid stones.Anuria has a relatively narrow differential and painless (partially non-dilated) bilateral ureteral obstruction is a distinctly unusual cause. A review of the literature to cover all reported causes of bilateral ureteral obstruction is presented. Only a minority of cases were not associated with an underlying malignant disease or its treatment. The multifactorial aetiology of the patient's acute kidney injury (volume depletion, diclofenac and obstructive uropathy) is presented and discussed. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. Endovascular correction of an infantile intracranial venous outflow obstruction.

    PubMed

    Soltanolkotabi, Maryam; Rahimi, Shahram; Hurley, Michael C; Bowman, Robin M; Russell, Eric J; Ansari, Sameer A; Shaibani, Ali

    2013-12-01

    The authors report on the case of a 7-year-old boy who presented with a reduced level of activity, macrocephaly, prominent scalp veins, and decreased left-sided visual acuity. Imaging workup demonstrated generalized cerebral volume loss, bilateral chronic subdural hematomas, absent left sigmoid sinus, hypoplastic left transverse sinus, and severe focal weblike stenosis of the right sigmoid sinus. Right sigmoid sinus angioplasty and stent insertion was performed, with an immediate reduction in the transduced intracranial venous pressure gradient across the stenosis (from 22 to 3 mm Hg). Postprocedural diminution of prominent scalp and forehead veins and spinal venous collateral vessels was followed by a progressive improvement in visual acuity and physical activity over a 1-year follow-up period, supporting the efficacy of angioplasty and stent insertion in intracranial venous outflow obstruction. There are multiple potential causes of intracranial venous hypertension in children. Development of dural sinus stenosis in infancy may be one such cause, mimicking the clinical presentation of other causes such as vein of Galen malformations. This condition can be ameliorated by early endovascular revascularization.

  2. The diagnosis of left ventricular outflow tract obstruction in hypertrophic cardiomyopathy.

    PubMed

    Piva e Mattos, Beatriz; Torres, Marco Antonio Rodrigues; Rebelatto, Taiane Francieli; Loreto, Melina Silva de; Scolari, Fernando Luís

    2012-07-01

    Hypertrophic cardiomyopathy is a prevalent genetic disease characterized by left ventricular hypertrophy, presenting dynamic obstruction of outflow tract with subaortic gradient happening at rest in 30% of the cases. It is attributed to the intricate interaction between the anterior mitral leaflet, the interventricular septum and altered flow vectors generated in left ventricle along with changes in outflow tract geometry. Mitral regurgitation in varying degrees is found with or without association with structural deformities of the valve apparatus. The exercise echocardiogram evidences latent obstruction easily induced by exercise in 60 to 75% of non-obstructive forms. The determination of the gradient under this condition must be considered in routine investigation of patients with mild or no obstruction at rest. The evaluation of hypertrophic cardiomyopathy incorporates methods based on the ultrasound image, which, along with MRI, allow recognizing ventricular obstruction generating mechanisms, thus facilitating the diagnosis and management of obstructive and latent obstructive forms.

  3. 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.

  4. Thulium laser resection for bladder neck obstruction in women.

    PubMed

    Huang, J H; Peng, B; Zheng, J H

    2014-06-01

    The aim of this paper was to investigate the efficacy of thulium laser resection of bladder neck in women with bladder neck obstruction (BNO). Clinical information of 86 women with BNO who were treated in our hospital from Jan 2011 to Dec 2012 was retrospectively reviewed; 46 patients received thulium laser resection (group 1), and the remaining patients were treated with standard electric resection (group 2). Maximum urinary flow rate (MFR), residual urine volume (RV), overactive bladder symptom score (OABSS) and quality of life (QOL) were determined before and after surgery. These patients were followed up at 1 week, 3 months, and 12 months after surgery. The RV levels after surgery in groups 1 were significantly lower than those before operation. MFR significantly increased after surgery when compared with preoperation, OABSS and QOL score markedly decreased at 3 months after surgery (P<0.05). Thulium laser resection had advantages in postoperative catheter retaining time (2.18±0.73 d vs. 4.24±1.01 d), postoperative hospitalization time (3.25±0.61 d vs. 4.73±1.41 d), Intraoperative blood loss (11.5±1.53 mL vs. 32.32±8.53 mL) and total cost ($1415±71 vs. $1148±59) over standard electric resection (P<0.05), but the operative time was comparable between two groups (18.36±5.45 min vs. 19.25±7.08 min) (P >0.05). In group 2, urethral stricture was seen in 1 patient, and two patients suffered from temporary incontinence, being back to normal in one month. However, urethral stricture and incontinence were not observed in group 1. Thulium laser resection is a simple, safe and effective strategy for the treatment of bladder neck obstruction in women.

  5. Hepatic venous outflow obstruction after transplantation: outcomes for treatment with self-expanding stents.

    PubMed

    Viteri-Ramírez, G; Alonso-Burgos, A; Simon-Yarza, I; Rotellar, F; Herrero, J I; Bilbao, J I

    2015-01-01

    To evaluate the safety and patency of self-expanding stents to treat hepatic venous outflow obstruction after orthotopic liver transplantation. To evaluate differences in the response between patients with early obstruction and patients with late obstruction. This is a retrospective analysis of 16 patients with hepatic venous outflow obstruction after liver transplantation treated with stents (1996-2011). Follow-up included venography/manometry, ultrasonography, CT, and laboratory tests. We did a descriptive statistical analysis of the survival of patients and stents, technical and clinical success of the procedure, recurrence of obstruction, and complications of the procedure. We also did an inferential statistical analysis of the differences between patients with early and late obstruction. The mean follow-up period was 3.34 years (21-5,331 days). The technical success rate was 93.7%, and the clinical success rate was 81.2%. The rate of complications was 25%. The survival rates were 87.5% for patients and 92.5% for stents. The rate of recurrence was 12.5%. The rate of primary patency was 0.96 (95% CI 0.91-1) at 3 months, 0.96 (95% CI 0.91-1) at 6 months, 0.87 (95% CI 0.73-1) at 12 months, and 0.87 (95% CI 0.73-1) at 60 months. There were no significant differences between patients with early and late obstruction, although there was a trend toward higher rates of primary patency in patients with early obstruction (P=.091). Treating hepatic venous outflow obstruction after orthotopic transplantation with self-expanding stents is effective, durable, and effective. There are no significant differences between patients with early obstruction and those with late obstruction. Copyright © 2013 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  6. Dynamic obstruction of the left ventricular outflow tract in four young dogs.

    PubMed

    Connolly, D J; Boswood, A

    2003-07-01

    Four young dogs presented for evaluation of left-sided systolic heart murmurs all showed echocardiographic changes consistent with dynamic left ventricular outflow tract (LVOT) obstruction and subjective evidence of concentric left ventricular hypertrophy. In three of the dogs, abnormal mitral valve apparatus and systolic anterior motion of the anterior mitral valve leaflet with associated mitral insufficiency were also detected. All dogs were medicated with a beta1-adrenergic antagonist. Subsequent examinations showed that the dynamic LVOT obstruction and left ventricular concentric hypertrophy had almost completely resolved. Dynamic LVOT obstruction is a rare condition of young dogs of different breeds. The precise aetiology of the condition remains uncertain. Whether resolution of the outflow obstruction in these four cases was a consequence of treatment or due to changes in ventricular architecture brought about by ageing cannot be established.

  7. 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

  8. Preventative effects of a HIF inhibitor, 17-DMAG on partial bladder outlet obstruction-induced bladder dysfunction.

    PubMed

    Iguchi, Nao; Dönmez, M İrfan; Malykhina, Anna P; Carrasco, Alonso; Wilcox, Duncan T

    2017-08-02

    Posterior urethral valves are the most common cause of partial bladder outlet obstruction (PBOO) in the pediatric population. Pathological changes in the bladder developed during PBOO are responsible for long-lasting voiding dysfunction in this population despite early surgical interventions. Increasing evidence showed PBOO induces an upregulation of Hypoxia inducible factors (HIFs) and their transcriptional target genes, and they play a role in pathophysiological changes in the obstructed bladders. We hypothesized that blocking HIF pathways can prevent PBOO-induced bladder dysfunction. PBOO was surgically created by ligation of the bladder neck in male C57BL/6J mice for 2 weeks. PBOO mice received intraperitoneal injection of either saline or 17-DMAG (Alvespimycin, 3mg/kg) every 48 h starting from day 1 post-surgery. Sham operated animals received injection of saline at the same schedule as PBOO mice and served as controls. The bladders were harvested after 2 weeks, and basal activity and evoked contractility of the detrusor smooth muscle (DSM) were evaluated in vitro Bladder function was assessed in vivo by void spot assay and cystometry in conscious, unrestrained mice. Results indicated the 17-DMAG treatment preserved DSM contractility, and partially prevented the development of detrusor over activity in obstructed bladders. In addition, PBOO caused a significant increase in the frequency of micturition which was significantly reduced by 17-DMAG treatment. The 17-DMAG treatment improved urodynamic parameters, including increases in the bladder pressure at micturition and non-void contractions observed in PBOO mice. These results demonstrate that treatment with 17-DMAG, a HIF inhibitor significantly alleviated PBOO-induced bladder pathology in vivo. Copyright © 2017, American Journal of Physiology-Renal Physiology.

  9. Giant Urinary Bladder and Bilateral Giant Hydronephrosis due to Bladder Neck Obstruction: One Case Report and Literature Review.

    PubMed

    Tazi, Mohammed Fadl; Riyach, Omar; Ahallal, Youness; Mellas, Soufiane; Khallouk, Abdelhak; El Fassi, Mohammed Jamal; Farih, Moulay Hassan

    2012-01-01

    Bilateral hydronephrosis secondary to urinary obstruction leads to a buildup of back pressure in the urinary tract and may lead to impairment of renal function. Cases of giant hydronephrosis are rare and usually contain no more than 1-2 litres of fluid in the collecting system. Here, we report a rarely seen case with giant urinary bladder and bilateral giant hydronephrosis due to bladder neck obstruction which contains 4000 mL fluid in the collecting system of the kidney mimicking an ascites in an adult male.

  10. Giant Urinary Bladder and Bilateral Giant Hydronephrosis due to Bladder Neck Obstruction: One Case Report and Literature Review

    PubMed Central

    Tazi, Mohammed Fadl; Riyach, Omar; Ahallal, Youness; Mellas, Soufiane; Khallouk, Abdelhak; El Fassi, Mohammed Jamal; Farih, Moulay Hassan

    2012-01-01

    Bilateral hydronephrosis secondary to urinary obstruction leads to a buildup of back pressure in the urinary tract and may lead to impairment of renal function. Cases of giant hydronephrosis are rare and usually contain no more than 1-2 litres of fluid in the collecting system. Here, we report a rarely seen case with giant urinary bladder and bilateral giant hydronephrosis due to bladder neck obstruction which contains 4000 mL fluid in the collecting system of the kidney mimicking an ascites in an adult male. PMID:22606637

  11. Deletion of neuropilin 2 enhances detrusor contractility following bladder outlet obstruction

    PubMed Central

    Vasquez, Evalynn; Cristofaro, Vivian; Lukianov, Stefan; Burkhard, Fiona C.; Monastyrskaya, Katia; Bielenberg, Diane R.; Sullivan, Maryrose P.; Adam, Rosalyn M.

    2017-01-01

    Chronic urethral obstruction and the ensuing bladder wall remodeling can lead to diminished bladder smooth muscle (BSM) contractility and debilitating lower urinary tract symptoms. No effective pharmacotherapy exists to restore BSM contractile function. Neuropilin 2 (Nrp2) is a transmembrane protein that is highly expressed in BSM. Nrp2 deletion in mice leads to increased BSM contraction. We determined whether genetic ablation of Nrp2 could restore BSM contractility following obstruction. Partial bladder outlet obstruction (pBOO) was created by urethral occlusion in mice with either constitutive and ubiquitous, or inducible smooth muscle–specific deletion of Nrp2, and Nrp2-intact littermates. Mice without obstruction served as additional controls. Contractility was measured by isometric tension testing. Nrp2 deletion prior to pBOO increased force generation in BSM 4 weeks following surgery. Deletion of Nrp2 in mice already subjected to pBOO for 4 weeks showed increased contractility of tissues tested 6 weeks after surgery compared with nondeleted controls. Assessment of tissues from patients with urodynamically defined bladder outlet obstruction revealed reduced NRP2 levels in obstructed bladders with compensated compared with decompensated function, relative to asymptomatic controls. We conclude that downregulation of Nrp2 promotes BSM force generation. Neuropilin 2 may represent a novel target to restore contractility following obstruction. PMID:28194441

  12. Deletion of neuropilin 2 enhances detrusor contractility following bladder outlet obstruction.

    PubMed

    Vasquez, Evalynn; Cristofaro, Vivian; Lukianov, Stefan; Burkhard, Fiona C; Gheinani, Ali Hashemi; Monastyrskaya, Katia; Bielenberg, Diane R; Sullivan, Maryrose P; Adam, Rosalyn M

    2017-02-09

    Chronic urethral obstruction and the ensuing bladder wall remodeling can lead to diminished bladder smooth muscle (BSM) contractility and debilitating lower urinary tract symptoms. No effective pharmacotherapy exists to restore BSM contractile function. Neuropilin 2 (Nrp2) is a transmembrane protein that is highly expressed in BSM. Nrp2 deletion in mice leads to increased BSM contraction. We determined whether genetic ablation of Nrp2 could restore BSM contractility following obstruction. Partial bladder outlet obstruction (pBOO) was created by urethral occlusion in mice with either constitutive and ubiquitous, or inducible smooth muscle-specific deletion of Nrp2, and Nrp2-intact littermates. Mice without obstruction served as additional controls. Contractility was measured by isometric tension testing. Nrp2 deletion prior to pBOO increased force generation in BSM 4 weeks following surgery. Deletion of Nrp2 in mice already subjected to pBOO for 4 weeks showed increased contractility of tissues tested 6 weeks after surgery compared with nondeleted controls. Assessment of tissues from patients with urodynamically defined bladder outlet obstruction revealed reduced NRP2 levels in obstructed bladders with compensated compared with decompensated function, relative to asymptomatic controls. We conclude that downregulation of Nrp2 promotes BSM force generation. Neuropilin 2 may represent a novel target to restore contractility following obstruction.

  13. Preventive Effect of Hydrogen Water on the Development of Detrusor Overactivity in a Rat Model of Bladder Outlet Obstruction.

    PubMed

    Miyazaki, Nozomu; Yamaguchi, Osamu; Nomiya, Masanori; Aikawa, Ken; Kimura, Junko

    2016-03-01

    Bladder ischemia and oxidative stress contribute to the pathogenesis of bladder dysfunction caused by bladder outlet obstruction. H2 reportedly acts as an effective antioxidant. We investigated whether oral ingestion of H2 water would have a beneficial effect on bladder function in a rat model of bladder outlet obstruction. H2 water was made by dissolving H2 gas in ordinary drinking water using a hydrogen water producing apparatus. The bladder outlet obstruction model was surgically induced in male rats. Rats with obstruction were fed H2 water or ordinary drinking water. On week 4 postoperatively cystometry was performed. Oxidative stress markers and the bladder nerve growth factor level were determined. Bladder tissues were processed for pharmacological studies and histological analysis. The micturition interval and micturition volume significantly decreased in obstructed rats given ordinary drinking water. These decreases were significantly suppressed by oral ingestion of H2 water. Increased post-void residual volume in obstructed rats was significantly reduced by H2 water. Obstruction led to a significant increase in bladder weight, oxidative stress markers and nerve growth factor. H2 water significantly suppressed these increases without affecting bladder weight. There was no significant difference in histological findings between rats with bladder obstruction given H2 water and ordinary drinking water. Decreased responses of detrusor muscle strips from obstructed bladders to KCl, carbachol and electrical field stimulation were reversed by H2 water ingestion. Results suggest that H2 water could ameliorate bladder dysfunction secondary to bladder outlet obstruction by attenuating oxidative stress. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  14. Septoplasty for left ventricular outflow obstruction without aortic valve replacement: a new technique.

    PubMed

    Cooley, D A; Garrett, J R

    1986-10-01

    A new technique is described for relief of diffuse obstruction in the left ventricular outflow tract without aortic valve replacement. Left ventricular septoplasty was performed, preserving the aortic valve. The supra-valve stenosis was repaired using a Y-shaped extension of the aortotomy proximally and a pantaloon-shaped patch of woven Dacron fabric. A 10-year-old girl with "tunnel" or diffuse stenosis obtained striking relief of left ventricular hypertension by this technique.

  15. Obstruction of left ventricular outflow tract by vegetation and periaortic abscess.

    PubMed

    Basmadjian, A J; Ducharme, A; Ugolini, P; Petitclerc, R; Leung, T K; Tardif, J C

    2000-09-01

    Echocardiography is the modality of choice for the noninvasive recognition of vegetations and abscesses that complicate endocarditis. Vegetation size is highly variable, and it has been suggested that large vegetations are related to a more complicated course. The case we present is unusual in that the echocardiographically detected vegetation was very large, highly mobile, and caused severe obstruction of the left ventricular outflow tract, which led to impaction and cardiac arrest.

  16. Manifestation of Latent Left Ventricular Outflow Tract Obstruction in the Acute Phase of Takotsubo Cardiomyopathy

    PubMed Central

    Ozaki, Kazuyuki; Okubo, Takeshi; Tanaka, Komei; Hosaka, Yukio; Tsuchida, Keiichi; Takahashi, Kazuyoshi; Oda, Hirotaka; Minamino, Tohru

    2016-01-01

    Objective Left ventricular outflow tract (LVOT) obstruction is a complication in 15-25% of patients with Takotsubo cardiomyopathy and sometimes leads to catastrophic outcomes, such as cardiogenic shock or cardiac rupture. However, the underlying mechanisms have not been clarified. Methods and Results We experienced 22 cases of Takotsubo cardiomyopathy during 3 years, and 4 of these 22 cases were complicated with LVOT obstruction in the acute phase (mean age 79±5 years, 1 man, 21 women). The LVOT pressure gradient in the acute phase was 100±17 mmHg. Transthoracic echocardiogram (TTE) revealed left ventricular hypertrophy (LVH) in one case and sigmoid-shaped septum without LVH in three cases. The complete resolution of the LVOT obstruction was achieved in a few days with normalization of the left ventricular wall motion following administration of beta-blockers. A dobutamine provocation test after normalization of the left ventricular wall motion reproduced the LVOT obstruction in all cases and revealed the presence of latent LVOT obstruction. Conclusion The manifestation of latent LVOT obstruction in the acute phase of Takotsubo cardiomyopathy is one potential reason for the complication of LVOT obstruction with Takotsubo cardiomyopathy. PMID:27904102

  17. Manifestation of Latent Left Ventricular Outflow Tract Obstruction in the Acute Phase of Takotsubo Cardiomyopathy.

    PubMed

    Ozaki, Kazuyuki; Okubo, Takeshi; Tanaka, Komei; Hosaka, Yukio; Tsuchida, Keiichi; Takahashi, Kazuyoshi; Oda, Hirotaka; Minamino, Tohru

    Objective Left ventricular outflow tract (LVOT) obstruction is a complication in 15-25% of patients with Takotsubo cardiomyopathy and sometimes leads to catastrophic outcomes, such as cardiogenic shock or cardiac rupture. However, the underlying mechanisms have not been clarified. Methods and Results We experienced 22 cases of Takotsubo cardiomyopathy during 3 years, and 4 of these 22 cases were complicated with LVOT obstruction in the acute phase (mean age 79±5 years, 1 man, 21 women). The LVOT pressure gradient in the acute phase was 100±17 mmHg. Transthoracic echocardiogram (TTE) revealed left ventricular hypertrophy (LVH) in one case and sigmoid-shaped septum without LVH in three cases. The complete resolution of the LVOT obstruction was achieved in a few days with normalization of the left ventricular wall motion following administration of beta-blockers. A dobutamine provocation test after normalization of the left ventricular wall motion reproduced the LVOT obstruction in all cases and revealed the presence of latent LVOT obstruction. Conclusion The manifestation of latent LVOT obstruction in the acute phase of Takotsubo cardiomyopathy is one potential reason for the complication of LVOT obstruction with Takotsubo cardiomyopathy.

  18. Intravesical foreign body–induced bladder calculi resulting in obstructive renal failure

    PubMed Central

    Kamal, Fadi; Clark, Aaron T.D.; Lavallée, Luke Thomas; Roberts, Matthew; Watterson, James

    2008-01-01

    We report the case of a 30-year-old man who presented with obstructive renal failure and urosepsis due to bladder outlet–obstructing bladder calculi that formed around 3 copper wires that were self-inserted into his urinary bladder 15 years previously. We present the evaluation, imaging and management of the unique complications resulting from the self-insertion of an intra-vesical foreign body. Our patient’s case was unique for 2 reasons. First, the length of time (15 yr) from foreign body insertion to presentation is the longest interval reported in the literature. Second, this is the first report of bladder calculi induced by the insertion of a foreign body that resulted in obstructive renal failure. PMID:18953457

  19. Dynamic left ventricular outflow tract obstruction secondary to catecholamine excess in a normal ventricle.

    PubMed

    Mingo, S; Benedicto, A; Jimenez, M C; Pérez, M A; Montero, M

    2006-10-10

    Hypertrophic cardiomyopathy (HCM) is the most common cause of left ventricular outflow tract (LVOT) obstruction. The LVOT obstruction is a consequence of the asymmetric septal hypertrophy and the mitral systolic anterior motion (SAM), causing both of them a dynamic gradient in LVOT. LVOT obstruction has been observed also in other conditions like hypertensive hypertrophy, dehydration, sepsis, vasodilatation, excessive sympathetic stimulation, pericardial tamponade, and after mitral valve repair and aortic valve replacement for aortic stenosis. We report in this document the case of two patients who developed a significant gradient at LVOT in the context of amine treatment during their admission into the intensive unit care. In both, cases there were no gradient, significant hypertrophy or SAM at baseline cardiac evaluation. We have met only one case reported in the literature matching those conditions. In order to treat this type of patients properly, it is essential to take in consideration this pathology.

  20. 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

  1. 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

    2014-03-07

    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.

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

    PubMed Central

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

    2014-01-01

    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. PMID:24605042

  3. 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. Copyright 2007 S. Karger AG, Basel.

  4. The influence of aortoseptal angulation on provocable left ventricular outflow tract obstruction in hypertrophic cardiomyopathy

    PubMed Central

    Critoph, Christopher Howell; Pantazis, Antonios; Tome Esteban, Maria Teresa; Salazar-Mendiguchía, Joel; Pagourelias, Efstathios D; Moon, James C; Elliott, Perry Mark

    2014-01-01

    Objectives Aortoseptal angulation (AoSA) can predict provocable left ventricular outflow tract obstruction (LVOTO) in patients with symptomatic hypertrophic cardiomyopathy (HCM). Lack of a standardised measurement technique in HCM without the need for complex three-dimensional (3D) imaging limits its usefulness in routine clinical practice. This study aimed to validate a simple measurement of AoSA using 2D echocardiography and cardiac MR (CMR) imaging as a predictor of LVOTO. Methods We retrospectively assessed 160 patients with non-obstructive HCM, referred for exercise stress echocardiography. AoSA was measured using resting 2D echocardiography in all patients, and CMR in 29. Twenty-five controls with normal echocardiograms were used for comparison. Results Patients with HCM had a reduced AoSA compared with controls (113°±12 vs 126°±6), p<0.0001. Sixty (38%) patients had provocable LVOTO, with smaller angles than non-obstructive patients (108°±12 vs 116°±12, p<0.0001). AoSA, degree of mitral valvular regurgitation and incomplete systolic anterior motion (SAM) were associated with peak left ventricular outflow tract gradient (r=0.508, p<0.0001). An angle ≤100° had 27% sensitivity, 91% specificity and 59% positive predictive value for predicting provocable LVOTO. When combined with SAM, specificity was 99% and positive predictive value 88%. Intraclass correlation coefficient of AoSA measured by two observers was 0.901 (p<0.0001). Bland-Altman analysis of echocardiographic AoSA showed good agreement with the CMR-derived angle. Conclusions Measurement of AoSA using echocardiography in HCM is easy, reproducible and comparable to CMR. Patients with provocable LVOTO have reduced angles compared with non-obstructive patients. AoSA is highly specific for provocable LVOTO and should prompt further evaluation in symptomatic patients without resting obstruction. PMID:25371813

  5. 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

  6. 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

  7. Characteristics of the mechanosensitive bladder afferent activities in relation with microcontractions in male rats with bladder outlet obstruction.

    PubMed

    Aizawa, Naoki; Ichihara, Koji; Fukuhara, Hiroshi; Fujimura, Tetsuya; Andersson, Karl-Erik; Homma, Yukio; Igawa, Yasuhiko

    2017-08-09

    We investigated the characteristics of bladder mechanosensitive single-unit afferent activities (SAAs) in rats with a bladder outlet obstruction (BOO) and their relationship with bladder microcontractions. Male Wistar rats were divided into Sham and BOO groups. Four or 10 days after the surgery, rats were anesthetized with urethane. The SAAs of Aδ- or C-fibers from the L6 dorsal roots were recorded during bladder filling. The BOO group showed a higher number of microcontractions and lower SAAs of Aδ-fibers compared with those of the Sham group. These findings were significant at day 10 post-operatively. In contrast, SAAs of C-fibers were not significantly different between the groups at either day 4 or 10. In the BOO group at day 10, the SAAs of both Aδ- and C-fibers at the "ascending" phase of microcontractions were significantly higher than those at the other phases (descending or stationary), and a similar tendency was also observed at day 4. Taken together, during bladder filling, the bladder mechanosensitive SAAs of Aδ-fibers were attenuated, but SAAs of both Aδ- and C-fibers were intermittently enhanced by propagation of microcontractions.

  8. HIF-mediated metabolic switching in bladder outlet obstruction mitigates the relaxing effect of mitochondrial inhibition.

    PubMed

    Ekman, Mari; Uvelius, Bengt; Albinsson, Sebastian; Swärd, Karl

    2014-05-01

    Prior work demonstrated increased levels of hypoxia-inducible factor-1α (HIF-1α) in the bladder following outlet obstruction, associated with bladder growth and fibrosis. Here we hypothesized that HIF induction in outlet obstruction also switches energetic support of contraction from mitochondrial respiration to glycolysis. To address this hypothesis, we created infravesical outlet obstruction in female Sprague-Dawley rats and examined HIF induction and transcriptional activation. HIF-1α increased after 6 weeks of outlet obstruction as assessed by western blotting and yet transcription factor-binding site analysis indicated HIF activation already at 10 days of obstruction. Accumulation HIF-2α and of Arnt2 proteins were found at 10 days, providing an explanation for the lack of correlation between HIF-1α protein and transcriptional activation. HIF signature targets, including Slc2a1, Tpi1, Eno1 and Ldha increased in obstructed compared with sham-operated bladders. The autophagy markers Bnip3 and LC3B-II were also increased at 6 week of obstruction, but electron microscopy did not support mitophagy. Mitochondria were, however, remodeled with increased expression of Cox4 compared with other markers. In keeping with a switch toward glycolytic support of contraction, we found that relaxation by the mitochondrial inhibitor cyanide was reduced in obstructed bladders. This was mimicked by organ culture with the HIF-inducer dimethyloxalylglycine, which also upregulated expression of Ldha. On the basis of these findings, we conclude that HIF activation in outlet obstruction involves mechanisms beyond the accumulation of HIF-1α protein and that it results in a switch of the energetic support of contraction to anaerobic glycolysis. This metabolic adaptation encompasses increased expression of glucose transporters and glycolytic enzymes combined with mitochondrial remodeling. Together, these changes uphold contractility when mitochondrial respiration is limited.

  9. Testosterone Modifies Alterations to Detrusor Muscle after Partial Bladder Outlet Obstruction in Juvenile Mice.

    PubMed

    Flum, Andrew S; Firmiss, Paula R; Bowen, Diana K; Kukulka, Natalie; Delos Santos, Grace B; Dettman, Robert W; Gong, Edward M

    2017-01-01

    Lower urinary tract symptoms secondary to posterior urethral valves (PUV) arise in boys during adolescence. The reasons for this have previously been attributed to increased urine output as boys experience increased growth. Additionally, there are few choices for clinicians to effectively treat these complications. We formed the new hypothesis that increased androgen levels at this time of childhood development could play a role at the cellular level in obstructed bladders. To test this hypothesis, we investigated the role of testosterone on bladder detrusor muscle following injury from partial bladder outlet obstruction (PO) in mice. A PO model was surgically created in juvenile male mice. A group of mice were castrated by bilateral orchiectomy at time of obstruction (CPO). Testosterone cypionate was administered to a group of castrated, obstructed mice (CPOT). Bladder function was assessed by voiding stain on paper (VSOP). Bladders were analyzed at 7 and 28 days by weight and histology. Detrusor collagen to smooth muscle ratio (Col/SM) was calculated using Masson's trichrome stain. All obstructed groups had lower max voided volumes (MVV) than sham mice at 1 day. Hormonally intact mice (PO) continued to have lower MVV at 7 and 28 days while CPO mice improved to sham levels at both time points. In accordance, PO mice had higher bladder-to-body weight ratios than CPO and sham mice demonstrating greater bladder hypertrophy. Histologically, Col/SM was lower in sham and CPO mice. When testosterone was restored in CPOT mice, MVV remained low at 7 and 28 days compared to CPO and bladder-to-body weight ratios were also greater than CPO. Histologic changes were also seen in CPOT mice with higher Col/SM than sham and CPO mice. In conclusion, our findings support a role for testosterone in the fibrotic changes that occur after obstruction in male mice. This suggests that while other changes may occur in adolescent boys that cause complication in boys with PUV, the

  10. Testosterone Modifies Alterations to Detrusor Muscle after Partial Bladder Outlet Obstruction in Juvenile Mice

    PubMed Central

    Flum, Andrew S.; Firmiss, Paula R.; Bowen, Diana K.; Kukulka, Natalie; Delos Santos, Grace B.; Dettman, Robert W.; Gong, Edward M.

    2017-01-01

    Lower urinary tract symptoms secondary to posterior urethral valves (PUV) arise in boys during adolescence. The reasons for this have previously been attributed to increased urine output as boys experience increased growth. Additionally, there are few choices for clinicians to effectively treat these complications. We formed the new hypothesis that increased androgen levels at this time of childhood development could play a role at the cellular level in obstructed bladders. To test this hypothesis, we investigated the role of testosterone on bladder detrusor muscle following injury from partial bladder outlet obstruction (PO) in mice. A PO model was surgically created in juvenile male mice. A group of mice were castrated by bilateral orchiectomy at time of obstruction (CPO). Testosterone cypionate was administered to a group of castrated, obstructed mice (CPOT). Bladder function was assessed by voiding stain on paper (VSOP). Bladders were analyzed at 7 and 28 days by weight and histology. Detrusor collagen to smooth muscle ratio (Col/SM) was calculated using Masson’s trichrome stain. All obstructed groups had lower max voided volumes (MVV) than sham mice at 1 day. Hormonally intact mice (PO) continued to have lower MVV at 7 and 28 days while CPO mice improved to sham levels at both time points. In accordance, PO mice had higher bladder-to-body weight ratios than CPO and sham mice demonstrating greater bladder hypertrophy. Histologically, Col/SM was lower in sham and CPO mice. When testosterone was restored in CPOT mice, MVV remained low at 7 and 28 days compared to CPO and bladder-to-body weight ratios were also greater than CPO. Histologic changes were also seen in CPOT mice with higher Col/SM than sham and CPO mice. In conclusion, our findings support a role for testosterone in the fibrotic changes that occur after obstruction in male mice. This suggests that while other changes may occur in adolescent boys that cause complication in boys with PUV, the

  11. Esophagogastric junction outflow obstruction is often associated with coexistent abnormal esophageal body motility and abnormal bolus transit.

    PubMed

    Zheng, E; Gideon, R M; Sloan, J; Katz, P O

    2017-10-01

    Currently, the diagnosis of esophageal motility disorders is in part based upon a hierarchical algorithm in which abnormalities of the esophagogastric junction (EGJ) is prioritized. An important metric in evaluating the EGJ is the integrated relaxation pressure (IRP). Patients who do not have achalasia but are found to have an elevated IRP are diagnosed with EGJ outflow obstruction. It has been our observation that a subset of these patients also has a second named motility disorder and may also have abnormal bolus transit. The aim of this study is to determine the frequency of abnormal body motility and or abnormal bolus movement in patients with EGJ outflow obstruction. Further, in an effort to evaluate the potential clinical value in measuring bolus transit as a complement to esophageal manometry, specifically in patients with EGJ outflow obstruction, we analyzed the presenting symptoms of these patients. A total of 807 patients with a mean age of 53 years completed esophageal function testing with impedance monitoring and high-resolution manometry between January 2012 and October 2016. There were 74 patients with achalasia who were excluded from the study. Of the remaining 733 patients, 138 (19%) had an elevated IRP and were given a diagnosis of EGJ outflow obstruction. Among these patients, 56 (40%) were diagnosed with an abnormal motility pattern to liquids (ineffective esophageal motility = 28, distal esophageal spasm = 19, Jackhammer = 6), of which 44 (76%) had abnormal bolus transit to liquids, viscous, or both. In contrast, there were 82 patients with EGJ outflow obstruction and normal esophageal motility, of which 33 (40%) had abnormal bolus transit. Patients with preserved esophageal motility and EGJ outflow obstruction were then evaluated. Of the 733 patients, 299 (40%) had intact esophageal motility. Of the 299 patients with normal esophageal motility, 56 patients had an elevated IRP, of which 16 (28%) had abnormal bolus transit. There were 243 (33

  12. Obstruction of the left ventricular outflow tract after mitral valvuloplasty with implantation of Gregori's ring.

    PubMed

    Carvalho, Roberto G de; Pimentel, Gustavo K; Oliveira, Luciano de; Silveira, Márcia M da; Alessi, Alexandre; Precoma, Dalton B

    2002-01-01

    Mitral valvuloplasty is efficient for repairing mitral valve disease with few complications. In some cases, obstruction of the left ventricular outflow tract may occur due to systolic anterior motion of the mitral valve. We report the case of a patient with this complication and a pressure gradient between the left ventricle and the aorta of 130 mm Hg after mitral valvuloplasty with implantation of a Gregori's ring. The management was clinical with suspension of the vasoactive drugs and introduction of a beta-blocker. Two years after the surgery, the patient is asymptomatic and has a normal life.

  13. 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.

  14. Late renal failure due to prostatic outflow obstruction: a preventable disease.

    PubMed Central

    Sacks, S. H.; Aparicio, S. A.; Bevan, A.; Oliver, D. O.; Will, E. J.; Davison, A. M.

    1989-01-01

    Nineteen patients presenting with late renal failure due to prostatic outflow obstruction (mean age 68.7 years; mean serum creatinine concentration 1158 mumol/l) were identified from the admission records of two renal units. As late renal failure secondary to prostatic enlargement is preventable case records were analysed retrospectively in an attempt to identify aspects of management in which preventive efforts might be of value. Delays in referral were common, with a mean of 2.8 years between the onset of prostatic symptoms and time of referral, six patients being referred who had had symptoms for more than three years. Four of five patients who had had a prostatectomy were known to be in renal failure at the time of operation but were not referred until 2-13 years later, when prostatic symptoms had recurred and there was evidence of progressive nephropathy with dilatation of the upper urinary tract. Two patients died on admission and eight (47% of survivors) required long term dialysis, most patients (80%) requiring some dialysis support during the initial period. These findings suggest that progressive nephropathy caused by prostatic outflow obstruction might, in part, be averted by more adequate screening of renal function in men with untreated prostatism and closer follow up of patients with uraemia at the time of prostatectomy. PMID:2466506

  15. Late renal failure due to prostatic outflow obstruction: a preventable disease.

    PubMed

    Sacks, S H; Aparicio, S A; Bevan, A; Oliver, D O; Will, E J; Davison, A M

    1989-01-21

    Nineteen patients presenting with late renal failure due to prostatic outflow obstruction (mean age 68.7 years; mean serum creatinine concentration 1158 mumol/l) were identified from the admission records of two renal units. As late renal failure secondary to prostatic enlargement is preventable case records were analysed retrospectively in an attempt to identify aspects of management in which preventive efforts might be of value. Delays in referral were common, with a mean of 2.8 years between the onset of prostatic symptoms and time of referral, six patients being referred who had had symptoms for more than three years. Four of five patients who had had a prostatectomy were known to be in renal failure at the time of operation but were not referred until 2-13 years later, when prostatic symptoms had recurred and there was evidence of progressive nephropathy with dilatation of the upper urinary tract. Two patients died on admission and eight (47% of survivors) required long term dialysis, most patients (80%) requiring some dialysis support during the initial period. These findings suggest that progressive nephropathy caused by prostatic outflow obstruction might, in part, be averted by more adequate screening of renal function in men with untreated prostatism and closer follow up of patients with uraemia at the time of prostatectomy.

  16. Two mathematical models explain the variation in cystometrograms of obstructed urinary bladders.

    PubMed

    Damaser, M S; Lehman, S L

    1996-12-01

    Overdistension of the urinary bladder, secondary to outlet obstruction, causes cellular changes in the bladder wall, including hypertrophy of the smooth muscle cells, which increase bladder mass. To investigate the effects of increased mass on the cystometrogram (CMG), we have developed two mathematical models. In the first model, we assume that mass is added such that the largest bladder volume at zero transmural pressure, the zero pressure volume (ZPV), is constant, It predicts increased pressures and decreased compliance in the CMG. In the second model, we assume that both mass and ZPV increase proportionally. It predicts unchanged pressures, increased compliance, and increased capacity in the CMG. These results allow use to divide animal experiments in the literature into two groups. Cystometrograms performed on animals that have had outlet obstruction induced by a cuff method, inducing a small increase in mass, belong to the first group: hypertrophy with no change in ZPV. Cystometrograms performed on animals that have had outlet obstruction induced by a ligature method, inducing a large increase in mass, belong to the second group: hypertrophy with increased ZPV. We conclude that increased ZPV results from a more severe obstruction which is indicated by the increased capacity and compliance.

  17. 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. Copyright © 2011. Published by Elsevier B.V.

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

    PubMed

    Takai, Idris Usman; Abubakar, Abdulkadir

    2016-01-01

    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. 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. 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. 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.

  19. [Interrelation of hyperactivity of bladder and infravesical obstruction in patients with benign prostate hyperplasia].

    PubMed

    Bablumyan, A

    2010-12-01

    The analysis of the data presented in the review convincingly shows the correlation between infravesical obstruction (IVO), caused by pressing of urethra by enlarged prostate, and the development of detrusor hyperactivity. The clinical importance of correlation between IVO and hyperactivity of the detrusor is convincingly illustrated by different results of effectiveness of surgical treatment of patients with benigh prostate hyperplasia (BPH) with and without hyperactivity of bladder. In patients with BPH and hyperactivity of bladder the probability of irritative symptoms is high. This data proves the necessity of the further study of the pathogenesis of development of bladder hyperactivity in patients with BPH, and the importance of a preoperative estimation of functional frustration of the bladder.

  20. 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

  1. Isolated Left Ventricular Apical Hypoplasia with Right Ventricular Outflow Tract Obstruction: A Rare Combination.

    PubMed

    Zhao, Yonghui; Zhang, Jiaying; Zhang, Jing

    2015-09-01

    Isolated left ventricular (LV) apical hypoplasia is a unusual and recently recognized congenital cardiac anomaly. A 19-year-old man was found to have an abnormal ECG and cardiac murmur identified during a routine health check since joining work. His ECG revealed normal sinus rhythm, right-axis deviation, poor R wave progression, and T wave abnormalities. On physical examination, a 2/6~3/6 systolic murmur was heard at the second intercostal space along the left sternal border. Subsequent echocardiography and cardiac magnetic resonance imaging confirmed the LV apical hypoplasia. Of note, we first found that LV apical hypoplasia was accompanied by RV outflow tract obstruction due to exaggerated rightward bulging of the basal-anterior septum during systole. A close follow-up was performed for the development of heart failure, pulmonary hypertension, and potentially tachyarrhythmia.

  2. The hypertensive lower esophageal sphincter: a motility disorder with manometric features of outflow obstruction.

    PubMed

    Gockel, Ines; Lord, Reginald V N; Bremner, Cedric G; Crookes, Peter F; Hamrah, Pedram; DeMeester, Tom R

    2003-01-01

    The aim of this study was to define the clinical presentation, motility characteristics, and prevalence and patterns of gastroesophageal reflux in patients with hypertensive lower esophageal sphincter (HTLES). HTLES was defined by a resting pressure measured at the respiratory inversion point on stationary manometry of greater than 26 mm Hg (ninety-fifth percentile of normal). One hundred consecutive patients (80 women, 20 men; mean age 54.7 years, range 23 to 89 years), diagnosed with HTLES at our institution between September 1996 and October 1999, were studied. Patients with achalasia or other named esophageal motility disorders or history of foregut surgery were excluded, but patients with both HTLES and "nutcracker esophagus" were included. The most common symptoms in patients with HTLES were regurgitation (75%), heartburn (71%), dysphagia (71%), and chest pain (49%). The most common primary presenting symptoms were heartburn and dysphagia. The intrabolus pressure, which is a manometric measure of outflow obstruction, was significantly higher in patients with HTLES compared to normal volunteers. The residual pressure measured during LES relaxation induced by a water swallow was also significantly higher than in normal persons. There were no significant associations between any of the relaxation parameters studied (residual pressure, nadir pressure, duration of relaxation, time to residual pressure) and either the presence or severity of any symptoms or the presence of abnormal esophageal acid exposure. Seventy-three patients underwent 24-hour pH monitoring, and 26% had increased distal esophageal acid exposure. Compared to a cohort of patients with gastroesophageal reflux disease but no HTLES (n=300), the total and supine periods of distal esophageal acid exposure were significantly lower in the patients with HTLES and abnormal acid exposure. Patients with HTLES frequently present with moderately severe dysphagia and typical reflux symptoms. Approximately one

  3. [Female urethral obstruction and bladder neck stenosis - fact or myth - how to proceed].

    PubMed

    Gunnemann, A; Liedl, B; Palma, P C R; Yoshimura, Y; Muctar, S

    2015-09-01

    The female urethra is probably the most neglected organ in women. Female urethral stricture and primary bladder neck obstruction are rare clinical entities. Traditional and new surgical techniques have been described for the treatment of female urethral stricture. However, they are based on limited data. There is no consensus on best management. The techniques of urethroplasty all have a higher mean success rate (80-94%) than urethral dilatation (< 50%), albeit with shorter mean follow-up. Urethroplasty performed by experienced surgeons appears to be a feasible option in women who have failed urethral dilatation, although there is a lack of high-level evidence to recommend one technique over another.Primary bladder neck obstruction (PBNO) is a condition in which the bladder neck fails to open adequately during voiding. This leads to increased striated sphincter activity or obstruction of urinary flow without another anatomic cause being present, for example an obstruction caused by genitourinary prolapse in women. Watchful waiting, pharmacotherapy and surgical intervention are possible treatments.

  4. Hepatic venous outflow obstruction after piggyback liver transplantation by an unusual mechanism: Report of a case

    PubMed Central

    Ng, Simon Siu-Man; Yu, Simon Chun-Ho; Lee, Janet Fung-Yee; Lai, Paul Bo-San; Lau, Wan-Yee

    2006-01-01

    Hepatic venous outflow obstruction after piggyback liver transplantation is a very rare complication. An unusual mechanism aggravating it is reported. A 33-year-old man with end-stage hepatitis B liver cirrhosis underwent a piggyback orthotopic liver transplantation using a full-size cadaveric graft. Two months after transplantation, he developed gross ascites refractory to maximal diuretic therapy. Doppler ultrasound showed patent portal and hepatic veins. Serial computed tomography scans revealed a hypoperfused right posterior segment of the liver which subsequently underwent atrophy. Hepatic venography demonstrated a high-grade stenosis with an element of torsion of venous drainage at the anastomosis. The stenosis was successfully treated with repeated percutaneous balloon angioplasty. The patient remained asymptomatic six months afterwards with complete resolution of ascites and peripheral edema. We postulate that liver allograft segmental hypoperfusion and atrophy may aggravate or result in a hepatic venous outflow problem by the mechanism of torsion effect. Percutaneous balloon angioplasty is a safe and effective treatment modality for anastomotic stenosis. PMID:16981282

  5. Combined usage of Ho:YAG laser with monopolar resectoscope in the treatment of bladder stone and bladder outlet obstruction

    PubMed Central

    Wu, Jian Hui; Yang, Kuo; Liu, Qian; Yang, Shi Qiang; Xu, Yong

    2014-01-01

    Objective: Bladder stones in elderly men are commonly associated with bladder outlet obstruction, and many different treatment modalities have been presented for both these conditions. To evaluate the effectiveness and safety of a novel method concerning spontaneous usage of both monopoplar transurethral resection of the prostate and Holmium Laser cystolithotripsy, we compared the transurethral use of resectoscope and cystoscope lithotripsy approaches retrospectively. Methods: Patients data of one hundred and nine male patients with benign prostatic hyperplasia (BPH) and bladder stone(s) were analyzed retrospectively. Two groups of patients were compared: Group I was treated with combination of transurethral holmium laser cystolithotripsy (HLC) and transurethral resection of the prostate (TURP) using the 24F resectoscope, and group II used 22F cystoscope and 24F resectoscope for treating both these conditions. Result: We reviewed the records of 109 patients undergoing transurethral cystolithotripsy with holmium laser and simultaneous TURP. The mean bladder stone size were 3.6±1.5 cm in Group-I and 3.7±1.1 cm (mean 3.8) in Group-II (p>0.05). The mean operation time of Group-I and Group-II was 49.0±22.5 minutes and 79.0±28.5 minutes, respectively (p<0.05). Stone fragments were removed completely and TURP procedures were done successfully in all of the patients. Mild hematuria was found more frequently in Group-II (22.2%), and four (7.4%) patients had urethral stricture in the same group during the late follow-up. Conclusion: Combination of transurethral laser cystolithotripsy and TURP using the same 24F resectooscope is an effective, safe and economical treatment for bladder stones in BPH patients. It is minimally invasive and involves and has lower complication rates and shorter hospital stay. However, this combined approach should be taken in the treatment of calculus within 4 or 5 centimeters. PMID:25097543

  6. Case of duplication of the urethra in an adult male, presenting with symptoms of bladder outlet obstruction.

    PubMed

    Slavov, Chavdar; Donkov, Ivo; Popov, Elenko

    2007-10-01

    Duplication of the urethra is a rare congenital anomaly, usually found in children and adolescents. The authors present a rare case of urethral duplication, presenting in a 58-yr-old man, with symptoms of bladder outlet obstruction.

  7. The inflexible mitral annulus after valve prosthesis. Inherent risk of dynamic left ventricular outflow tract obstruction.

    PubMed

    Komoda, T; Hetzer, R; Oellinger, J; Siniawski, H; Hofmeister, J; Hübler, M; Felix, R; Uyama, C; Maeta, H

    1996-01-01

    Although chordal preserving mitral valve replacement is beneficial to cardiac function, the loss of flexibility of the annulus and consequent translational motion of the valve prosthesis during systole may cause potential left ventricular outflow tract (LVOT) obstruction after surgery. The extent of the flexibility of the mitral valve annulus (MVA) necessary for the prosthetic valve to prevent potential LVOT obstruction was determined. The three dimensional images of the MVA at 0, 100, 200, and 300 msec delay from the electrocardiogram R wave were reconstructed from cine-mode magnetic resonance images in eight normal subjects. In the lateral view of the MVA, the dorsal flexion angle (DFA) was defined. This angle implies the extent of the flexion of the anterior half of the MVA in relation to the posterior half. The data (mean +/- SD) for the DFA were 31.7 +/- 5.4 degrees (0 msec), 36.4 +/- 4.5 degrees (100 msec), 39.0 +/- 3.8 degrees (200 msec), and 43.6 +/- 2.6 degrees (300 msec), whereas the systolic increase in DFA was 11.9 +/- 3.2 degrees. The flexibility observed in normal mitral annuli is relevant to prosthetic mitral valves.

  8. 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.

  9. 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

  10. Cannabinor, a selective cannabinoid-2 receptor agonist, improves bladder emptying in rats with partial urethral obstruction.

    PubMed

    Gratzke, Christian; Streng, Tomi; Stief, Christian G; Alroy, Iris; Limberg, Brian J; Downs, Thomas R; Rosenbaum, Jan S; Hedlund, Petter; Andersson, Karl-Erik

    2011-02-01

    We studied the effects of chronic treatment with the novel selective cannabinoid 2 receptor agonist cannabinor (Procter & Gamble Pharmaceuticals, Cincinnati, Ohio) on bladder function in conscious rats with partial urethral obstruction and on the functional properties of isolated detrusor muscle. A total of 24 female Sprague-Dawley® rats with surgically created partial urethral obstruction received daily intraperitoneal injections of 3 mg/kg cannabinor (12) or saline as controls (12) for 2 weeks. Cystometry was done, the rats were sacrificed and the bladders were prepared for in vitro studies. Mean ± SEM bladder weight was 0.97 ± 0.15 gm in controls and 0.53 ± 0.08 gm in cannabinor treated rats (p <0.05). There was no difference between the groups in the mean micturition interval, or mean baseline, threshold, flow or maximum pressure. In controls and cannabinor treated rats mean post-void residual volume was 0.28 ± 0.07 and 0.06 ± 0.02 ml, mean micturition compliance was 0.032 ± 0.006 and 0.069 ± 0.016 ml/cm H(2)O, and mean bladder wall force at the start of flow was 950 ± 280 and 1,647 ± 325 mN/gm, respectively (each p <0.05). Nonvoiding contractions were significantly less frequent in cannabinor treated rats than in controls. We noted no difference in carbachol (Sigma®) half maximum concentration between the groups but the carbachol maximum response in detrusor strips from cannabinor treated rats was significantly higher than that in control strips. In rats with partial urethral obstruction treated daily for 14 days with cannabinor bladder weight was lower, the ability to empty the bladder was preserved and nonvoiding contraction frequency was low compared to those in controls. Detrusor preparations from cannabinor treated rats showed a higher response to nerve stimulation than those from controls. Selective cannabinoid 2 receptor activation may be a novel principle to enable improved bladder function after partial urethral obstruction. Copyright

  11. Gall-bladder agenesis presenting with obstructive jaundice and elevated CA 19-9.

    PubMed

    Trompetas, V; Panagopoulos, E; Ramantanis, G

    2004-06-01

    We report the case of an 81-year-old man with agenesis of the gall-bladder that presented with choledocholithiasis, obstructive jaundice, and very high CA 19-9 serum level (2765 U/ml). On ultrasound and CT scan, the gallbladder was not visualised and it was assumed shrunken and filled with gall-stones. After repeated unsuccessful endoscopic retrograde cholangiopancreatography, the patient was operated on for common bile duct (CBD) stones. At laparotomy the gall-bladder was not identified but a 3 cm long gall-stone was removed from the CBD. After decompression of the CBD all symptoms disappeared and the CA 19-9 returned to normal. We believe that this is the first report in the literature of gall-bladder agenesis presenting with high serum level of CA 19-9.

  12. Increased Urinary Adenosine Triphosphate in Patients With Bladder Outlet Obstruction Due to Benign Prostate Hyperplasia.

    PubMed

    Silva-Ramos, Miguel; Silva, Isabel; Oliveira, José Carlos; Correia-de-Sá, Paulo

    2016-11-01

    Diagnosis of bladder outflow obstruction (BOO) in patients with lower urinary tract (LUT) symptoms is challenging without using invasive urodynamic tests. Recently, we showed in vitro that urothelial strips from patients with benign prostatic hyperplasia (BPH) release more ATP than controls. Here, we tested whether urinary ATP can be used as a wall tension transducer non-invasive biomarker to detect BOO in patients with BPH. 79 male patients with BOO and 22 asymptomatic controls were recruited prospectively. Patients were asked to complete the International Prostate Symptom Score (IPSS) questionnaire and to void at normal desire into a urinary flowmeter; the postvoid residual volume was determined by suprapubic ultrasonography. Urine samples from all individuals were examined for ATP, creatinine, and lactate dehydrogenase. BOO patients had significantly higher (P < 0.001) urinary ATP normalized by the voided volume (456 ± 36 nmol) than age-matched controls (209 ± 35 nmol). Urinary ATP amounts increased with the voided volume, but the slope of this rise was higher in BOO patients than in controls. A negative correlation was detected between urinary ATP and flow rate parameters, namely maximal flow rate (r = -0.310, P = 0.005), Siroky flow-volume normalization (r = -0.324, P = 0.004), and volume-normalized flow rate index (r = -0.320, P = 0.012). We found no correlation with LUT symptoms IPSS score. Areas under the receiver operator characteristics (ROC) curves were 0.91 (95%CI 0.86-0.96, P < 0.001) for ATP alone and 0.88 (95%CI 0.81-0.94, P < 0,001) when adjusted to urinary creatinine. Patients with BOO release higher amounts of ATP into the urine than the control group. The high area under the ROC curve suggests that urinary ATP can be a high-sensitive non-invasive biomarker of BOO, which may have a discriminative value of detrusor competence when comparing BPH patients with low urinary flow rates. Prostate 76

  13. 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.

  14. Smooth muscle trans-membrane sarcoglycan complex in partial bladder outlet obstruction.

    PubMed

    Macarak, Edward J; Schulz, Jake; Zderic, Stephen A; Sado, Yoshikazu; Ninomiya, Yoshifumi; Polyak, Erzsebet; Chacko, Samuel; Howard, Pamela S

    2006-07-01

    The urinary bladder experiences both distension and contraction as a part of the normal filling and emptying cycle. To empty properly, tension generated intracellularly in a smooth muscle cell must be smoothly and efficiently transferred across its sarcolemma to the basement membrane, which mediates its binding to both the extracellular matrix and to other cells. As a consequence of urethral obstruction, the bladder cannot generate appropriate force to contract the organ, thereby leading to inefficient emptying and associated sequelae. In this study, an animal model of urethral obstruction was utilized to study the membrane-associated structures that transfer tension across the sarcolemma of bladder smooth muscle cells. Immunohistochemical localization of key components of the smooth muscle tension transfer apparatus (TTA) was performed utilizing specific antibodies against:(1) the alpha-chains of type IV collagen, a basement membrane component, and (2) beta-sarcoglycan, an integral membrane protein that is a participant in the physical linkage between the cytoskeleton and the basement membrane. We demonstrate, in obstructed animals, that there is a pronounced disruption of the TTA with a physical displacement of these two components that can be demonstrated at the level of the light microscope using scanning confocal microscopy. Electron microscopy further demonstrates significant increases in the size of the junctional plaques between smooth muscle cells.

  15. Impaired adrenergic- and corticotropic-axis outflow during exercise in chronic obstructive pulmonary disease.

    PubMed

    Iranmanesh, Ali; Rochester, Dudley F; Liu, Jing; Veldhuis, Johannes D

    2011-11-01

    Exercise stimulates coordinated release of the sympathoadrenal hormones adrenocorticotropic hormone (ACTH), cortisol, norepinephrine (NE), and epinephrine (Epi). The study hypothesis was that chronic obstructive pulmonary disease (COPD) is marked by heightened sympathoadrenal outflow at comparable relative workloads. The location of the study was at a clinical research unit. Eight healthy men and 9 men with stable COPD (forced expiratory volume at 1 second <75% predicted) were studied. Volunteers rested (baseline) or exercised at individual submaximal (35% ± 5%) or maximal oxygen consumption. Blood was sampled every 2 minutes for 40 minutes concurrently. Two-way analysis of covariance was applied to examine group (healthy/COPD) and exercise (3 levels) effects on ACTH, cortisol, NE, and Epi release and regularity (estimable by approximate entropy). The timing of peak hormone concentrations was Epi, 14 minutes; NE, 16 minutes; ACTH, 22 minutes; and cortisol, 34 minutes in both cohorts. Type of exercise regimen influenced all 4 hormones (each P < .001), and subject group (control vs COPD) affected cortisol (P < .001) and Epi (P = .048) responses. Exercise regimen and group together controlled ACTH, cortisol, and Epi (each P < .001), but not NE, responses. In particular, endocrine responses were attenuated in COPD compared with control subjects. Approximate entropy analysis also identified loss of maximal exercise-induced ACTH-secretory regularity in COPD patients (P = .042). These outcomes demonstrate impaired rather than augmented exercise-associated sympathocorticotropic-axis outflow in patients with COPD even when outcomes are normalized to maximal oxygen consumption, suggesting that factors other than fitness are at work.

  16. AB283. SPR-10 Down-regulation of ryanodine receptor gene expression in murine urinary bladder smooth muscle following partial bladder outlet obstruction

    PubMed Central

    Boopathi, Ettickan; Javed, Elham; Addya, Shankar; Fortina, Paolo; Zderic, Stephen; Wein, Alan; Chacko, Samuel

    2016-01-01

    Objective Urinary bladder smooth muscle (UBSM) displays spontaneous action potentials and this potential is related to the phasic nature of spontaneous contractions in this tissue. The amplitude of a phasic contraction depends on the increase in Ca2+ entry caused by membrane depolarization. Ryanodine receptors (RyRs) in UBSM decreases the force production by decreasing the frequency of phasic contractions through interactions with large-conductance Ca2+-activated K+ (BK) and small-conductance Ca2+-activated K+ (SK) channels. Microarray and network analysis were employed to determine the changes in mRNA in 14-day obstructed murine bladders. We found that obstruction significantly down-regulated the RyRs in bladder smooth muscle (BSM). Methods Male C57Bl/6 mice were surgically obstructed and kept for 14 days. Sham-operated mice served as a control. Bladders were excised; urothelium scraped off with a scalpel, and the serosa was removed. BSM obtained from PBOO and sham control animals were used for microarray and western blotting Results Pathway-based analysis of these gene signatures showed significant number of under-expressed genes in obstructed bladder and they were mapped to proteins involved in calcium signaling. We focused our work on RyR protein expression in BSM. There was a four-fold reduction of RyR3 in BSM in 14-day obstructed groups as shown by microarray and immunoblotting compared to that of sham-operated animals. Conclusions These results confirm that the RyR gene expression is down-regulated in obstructed murine bladder smooth muscle. Funding Source(s) None

  17. Molecular Mechanisms of Bladder Outlet Obstruction in Transgenic Male Mice Overexpressing Aromatase (Cyp19a1)

    PubMed Central

    Lin, Wei; Rahman, Nafis A.; Lin, Jian; Zhang, Hua; Gou, Kemian; Yu, Wanpeng; Zhu, Dahai; Li, Ning; Huhtaniemi, Ilpo; Li, Xiangdong

    2011-01-01

    We investigated the etiology and molecular mechanisms of bladder outlet obstruction (BOO). Transgenic (Tg) male mice overexpressing aromatase (Cyp19a1) under the ubiquitin C promoter in the estrogen-susceptible C57Bl/6J genetic background (AROM+/6J) developed inguinal hernia by 2 months and severe BOO by 9 to 10 months, with 100% penetrance. These mice gradually developed uremia, renal failure, renal retention, and finally died. The BOO bladders were threefold larger than in age-matched wild-type (WT) males and were filled with urine on necropsy. Hypotrophic smooth muscle cells formed the thin detrusor urinae muscle, and collagen III accumulation contributed to the reduced compliance of the bladder. p-AKT and ERα expression were up-regulated and Pten expression was down-regulated in the BOO bladder urothelium. Expression of only ERα in the intradetrusor fibroblasts suggests a specific role of this estrogen receptor form in urothelial proliferation. Inactivation of Pten, which in turn activated the p-AKT pathway, was strictly related to the activation of the ERα pathway in the BOO bladders. Human relevance for these findings was provided by increased expression of p-AKT, PCNA, and ERα and decreased expression of PTEN in severe human BOO samples, compared with subnormal to mild samples. These findings clarify the involvement of estrogen excess and/or imbalance of the androgen/estrogen ratio in the molecular pathogenetic mechanisms of BOO and provide a novel lead into potential treatment strategies for BOO. PMID:21356374

  18. Left ventricular outflow tract obstruction following an uncomplicated primary percutaneous coronary intervention: a recognized but rare cause of cardiogenic shock

    PubMed Central

    Khan, S; Ripley, DP; de Belder, MA; Goodwin, AT; Barham, N

    2013-01-01

    Dynamic left ventricular outflow tract obstruction is a rare but important complication of myocardial infarction. It occurs acutely and may mimic the presentation of papillary muscle rupture or acquired ventricular septal defect. Unlike these mechanical complications, it does not require circulatory support or cardiac surgical intervention. Recognition is critical because it typically responds to volume loading and beta blockade. We report a case who displayed many classical features of this condition. PMID:24062935

  19. 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.

  20. Hepatic venous outflow obstruction in piggyback liver transplantation: single centre experience.

    PubMed

    Arudchelvam, Joel; Bartlett, Adam; McCall, John; Johnston, Peter; Gane, Edward; Munn, Stephen

    2017-03-01

    Hepatic venous outflow obstruction (HVOO) is a rare but serious complication in liver transplantation (LT). We conducted a retrospective analysis of HVOO with venography and gradient measurement in consecutive LT from a single centre. Five hundred and six LTs were performed in 486 patients with a median age of 49 years (range 3 months to 71 years). Nineteen (3.8%) cases of HVOO were identified. Diagnosis was confirmed at a median of 26 days post-LT (1-2312). The incidence fell from 5.5% in the first 253 LT, to 2.0% in the second 253 (P = 0.03). Seventeen were due to narrowing at the anastomosis and two cases were due to thrombosis. In adult patients, reconstruction of the supra-hepatic donor inferior vena cava (IVC) onto two veins versus modified 2-3 hepatic veins did not alter the likelihood of HVOO. 17/19 cases were managed successfully by stenting or venoplasty. Two paediatric patients with early onset HVOO had attempted surgical thrombectomy, one was successful and the other required retransplantation. The incidence of HVOO appears to fall with increasing experience and does not appear to be related to the number of veins the donor IVC is anastomosed to in adult recipients. © 2015 Royal Australasian College of Surgeons.

  1. Surgical Treatment for Double Outlet Right Ventricle With Pulmonary Outflow Tract Obstruction.

    PubMed

    Wu, Qingyu; Jin, Yongqiang; Li, Hongyin; Zhang, Mingkui

    2016-11-01

    Double outlet right ventricle (DORV) is a conotruncal anomaly that is a defining element of many types of complex congenital heart disease. Because of a big variety of pathology, there are still some controversies with respect to the definition, classification, and surgical treatment. We report our experience with surgical treatment for DORV (as defined by the "90% rule") with pulmonary outflow tract obstruction (POTO). From July 2005 to July 2015, 90 patients underwent surgical treatment of DORV with POTO at the First Hospital of Tsinghua University. There were 55 males and 35 females whose age varies from 3 months to 36 years (mean age 7.1 ± 9.0 years old), and body weights ranged from 5 to 63 kg (mean weight 20.4 ± 16.6 kg). Besides DORV, ventricular septal defect, and POTO, this group of patients includes some with additional associated cardiac abnormalities. Fourteen patients (15.6%) died. The main cause of death was low cardiac output syndrome. The DORV is usually associated with a variety of cardiac abnormalities and POTO is a common defining feature. Acceptable surgical results can be achieved by individualized surgical treatment of most patients. Some patients may require reoperation, and a close follow-up is needed. © The Author(s) 2016.

  2. Surgery for infants with a hypoplastic systemic ventricle and severe outflow obstruction: early results with a modified Norwood procedure.

    PubMed Central

    Bu'Lock, F. A.; Stümper, O.; Jagtap, R.; Silove, E. D.; De Giovanni, J. V.; Wright, J. G.; Sethia, B.; Brawn, W. J.

    1995-01-01

    OBJECTIVE--Prospective audit of the first year of implementation of a modified approach to palliation for infants with hypoplastic systemic ventricle and severe systemic outflow obstruction. SETTING--Tertiary referral centre for neonatal and infant cardiac surgery. PATIENTS AND METHODS--17 of 19 infants (aged < 35 days) presenting to Birmingham Children's Hospital in 1993 with hypoplastic systemic ventricle and severe outflow obstruction underwent surgery. This was performed using a new modification of the Norwood-type arch repair, without the use of exogenous material, and a 3.5 mm Gore-tex shunt between the innominate and right pulmonary arteries. The Gore-tex shunt was replaced by a cavopulmonary shunt between 3 and 5 months later. Clinical, morphological, and functional determinants of outcome were examined. RESULTS--10 (59%) infants survived initial surgery. All proceeded to cavopulmonary shunt without further loss. Significant atrioventricular valve regurgitation seemed to be the main risk factor for poor outcome. If this was excluded, the morphology of the dominant ventricle seemed to have little effect on the outcome of initial surgery. CONCLUSIONS--Early survival was achieved in 59% of patients in the first year of implementation of a protocol for surgery in infants with hypoplastic systemic ventricle and severe outflow obstruction. The construction of a neoaorta without the use of exogenous material may allow improved later growth of the neoaorta. Early cavopulmonary shunt can be performed safely and should reduce mid-term complications from cyanosis and systemic ventricular volume loading. PMID:7540406

  3. Urethrolysis with Martius labial fat pad graft for iatrogenic bladder outlet obstruction.

    PubMed

    Carey, Jeffrey M; Chon, Joanna K; Leach, Gary E

    2003-04-01

    This article evaluates treatment outcomes of urethrolysis with the Martius labial fat pad graft for patients with outlet obstruction after incontinence surgery. A total of 23 women were diagnosed with iatrogenic bladder outlet obstruction by urinary retention, urodynamic criteria, physical examination findings, and/or temporal relation of voiding dysfunction to anti-incontinence surgery. The urodynamic definition of female outlet obstruction was a maximum flow rate <12 mL/sec and a detrusor pressure at maximum flow >20 cm of water. Surgical treatment consisted of urethrolysis with complete circumferential urethral mobilization. A Martius labial fat pad graft was used to circumferentially wrap the urethra. No concurrent resuspension procedures were performed. Procedure efficacy was determined by retrospective review and phone interview. Mean patient age was 55 years (range, 37 to 85 years). Mean postoperative follow-up time was 15 months (maximum, 44 months). All patients related voiding dysfunction symptoms to their anti-incontinence surgery. In all, 17 of 23 (74%) patients had preoperative urinary retention requiring catheterization, and 63% of patients met urodynamic criteria for obstruction. After urethrolysis with a Martius labial fat pad graft, 20 of 23 (87%) patients had complete resolution of their obstruction; 3 patients required persistent catheterization. Postoperative stress incontinence was reported by 6 of 23 (13%) patients. Urodynamically documented detrusor instability occurred in 6 of 23 (26%) patients with de novo detrusor instability occurring in 3 of 15 (20%) patients.

  4. Effect of Doxazosin on Autonomic Nervous Control and Urodynamics of Rat Urinary Bladder during Modeled Infravesical Obstruction.

    PubMed

    Kirpatovskii, V I; Mudraya, I S; Revenko, S V; Bablumyan, A Yu; Adamyan, N K; Ivanov, V P

    2016-09-01

    The therapeutic effect of doxazosin (40 μg/kg/day over one month) on urinary bladder was examined in female rats with modeled chronic infravesical obstruction (IVO) produced by graduated mechanical constriction of the proximal urethral segment. In one month, IVO induced a pronounced vesical hypertrophy both in treated and untreated rats that manifested in increased bladder weight and capacity, the latter increment being pronouncedly greater in treated rats. In untreated IVO rats, infusion cystometry revealed elevated basal intravesical pressure of void bladder P0, markedly increased maximal (premicturitional) pressure Pmax, and increased amplitude of spontaneous oscillations of intravesical pressure ΔPdet in filled bladder. Doxazosin produced no significant effect on Pmax rise during IVO, but prevented elevation of P0 and increment of ΔPdet in filled bladder. During gradual filling of urinary bladder in control (intact) rats, the parasympathetic vesical influences increased progressively, while in untreated IVO rats, the adrenergic influences prevailed even at maximal filling of the bladder. In IVO rats, doxazosin prevented the bias of the sympathetic-parasympathetic balance in the filled bladder in favor of sympathetic influences, but did not prevent this bias in a void bladder. It is hypothesized that α-adrenoblockers improve micturition during IVO caused by benign prostatic hyperplasia not only by decreasing the urethral resistance to urine flow due to down-regulation of prostate smooth muscle tone, but also by a direct action of these blockers on detrusor adrenergic receptors and central structures involved in urinary bladder control.

  5. Symptomatic exercise-induced left ventricular outflow tract obstruction without left ventricular hypertrophy.

    PubMed

    Alhaj, Eyad K; Kim, Bette; Cantales, Deborah; Uretsky, Seth; Chaudhry, Farooq A; Sherrid, Mark V

    2013-05-01

    Left ventricular (LV) outflow tract obstruction (LVOTO) is most commonly seen in patients with hypertrophic cardiomyopathy. Postexercise dynamic LVOTO (DLVOTO) has been infrequently identified in symptomatic patients without LV hypertrophy, and its pathophysiology is not well established. The aim of this study was to identify echocardiographic abnormalities that might explain the dynamic development of systolic anterior motion, mitral-septal contact, and LVOTO in these patients. Patients with DLVOTO and normal wall thickness were compared with 20 age-matched and gender-matched controls with normal stress echocardiographic findings. Two other groups were also compared: patients with DLVOTO and mild segmental hypertrophy (segmental wall thickness ≤15 mm) and patients with normal left ventricles but DLVOTO after dobutamine stress. Six symptomatic patients were identified (mean age, 48 ± 9 years; range, 37-60 years; five men) with normal wall thickness who developed DLVOTO after exercise during a 6-year period. Five had been hospitalized for cardiac symptoms. The mean postexercise LV outflow tract gradient caused by systolic anterior motion mitral-septal contact was 107 ± 55 mm Hg (range, 64-200 mm Hg). All patients had echocardiographic LV wall thicknesses in the normal range (≤12 mm). Structural abnormalities of the mitral valve were identified in all six patients. These were elongated posterior leaflets (2.0 vs 1.5 cm, P < .0005), elongated anterior leaflets (3.2 vs 2.6 cm, P = .015), increased protrusion height of the mitral valve beyond the mitral annular plane (2.6 vs 0.6 cm, P < .00001), and residual protruding portions of the mitral valve leaflets (0.85 vs 0.24 cm, P < .005). There was anterior positioning of the papillary muscles in the LV cavity, with a greater distance from the plane of the papillary muscles to the posterior wall (1.8 vs 1.3 cm, P = .03). In two patients, potentially provoking medications were stopped; two patients received

  6. Rhabdomyosarcoma of prostate presenting as bladder outlet obstruction in a young adult

    PubMed Central

    Prabhakaran, Pranab; Sanjayan, Rajitha; Somanathan, Thara; Narayanan, Geetha

    2013-01-01

    A 19-year-old boy presented with bladder outlet obstruction and on evaluation was found to have prostatomegaly, which on biopsy was diagnostic of embryonal rhabdomyosarcoma (RMS). He had pulmonary metastasis and received chemotherapy with cyclophosphamide, doxorubicin, vincristine, actinomycin D, and radical radiotherapy. At one year, his prostatic tumour has resolved completely. Embryonal RMS of prostate occurs more commonly in infancy and childhood, so occurrence in young adults is rare, and a high index of suspicion is essential for early diagnosis and treatment. PMID:24143154

  7. Rhabdomyosarcoma of prostate presenting as bladder outlet obstruction in a young adult.

    PubMed

    Prabhakaran, Pranab; Sanjayan, Rajitha; Somanathan, Thara; Narayanan, Geetha

    2013-01-01

    A 19-year-old boy presented with bladder outlet obstruction and on evaluation was found to have prostatomegaly, which on biopsy was diagnostic of embryonal rhabdomyosarcoma (RMS). He had pulmonary metastasis and received chemotherapy with cyclophosphamide, doxorubicin, vincristine, actinomycin D, and radical radiotherapy. At one year, his prostatic tumour has resolved completely. Embryonal RMS of prostate occurs more commonly in infancy and childhood, so occurrence in young adults is rare, and a high index of suspicion is essential for early diagnosis and treatment.

  8. Improving left ventricular outflow tract obstruction repair in common atrioventricular canal defects.

    PubMed

    Myers, Patrick O; del Nido, Pedro J; Marx, Gerald R; Emani, Sitaram; Mayer, John E; Pigula, Frank A; Baird, Christopher W

    2012-08-01

    Left ventricular outflow tract obstruction (LVOTO) is the second most frequent reason for reoperation after atrioventricular canal (AVC) defect repair. Limited data are available on the mechanisms of LVOTO, their treatment, and outcomes. Between 1998 and 2010, 56 consecutive children with AVC underwent 68 LVOTO procedures. The AVC was partial in 4, transitional in 9, and complete in 43. The LVOTO procedure was required in 21 patients at the primary AVC repair, and the initial LVOTO procedure in 35 patients was a late reoperation after AVC repair. During a mean follow-up of 50±41 months, 5 patients (24%) with LVOTO repair at AVC repair required a reoperation for LVOTO, and 7 patients (20%) whose initial LVOTO repair was a reoperation required a second reoperation for LVOTO repair. Overall freedom from LVOTO reoperation was 98.5% at 1 year, 92.5% at 3 years, 81% at 5 years, 72.2% at 7 years, and 52.5% at 10 and 12 years. The freedom from reoperation was neither significantly different between partial, transitional, and complete AVC (p=0.78) nor between timing of the LVOT procedure (p=0.49). Modified single-patch AVC repair was associated with a higher LVOTO reoperation rate (p=0.04). Neither the mechanisms leading to LVOTO nor the surgical techniques used were independent predictors of reoperation. LVOTO in AVC is a complex and multifactorial disease. Aggressive surgical repair has improved late outcomes; however, risk factors for reoperation and the ideal approach for repair remain to be defined. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Intermediate-term efficacy of Tm:YAG laser prostate vaporesection for bladder outlet obstruction: initial experience from a UK teaching hospital.

    PubMed

    Pal, Raj P; Khan, Masood A

    2012-01-01

    To assess the safety and clinical efficacy of Tm:YAG laser vaporesection of the prostate (ThuVaRP) at intermediate-term follow-up. We identified the first 60 consecutive patients who underwent ThuVaRP at our institute. Operative outcomes assessed were resection time, resection weight, drop in haemoglobin, transfusion rate, catheter time and complication rate. The International Prostate Symptom Score (IPSS) was documented at a mean follow-up period of 19 months postoperatively. 45/60 patients underwent treatment due to lower urinary tract symptoms secondary to benign prostatic obstruction, 11/60 patients had a long-term catheter in situ for refractory urinary retention secondary to benign prostatic obstruction, and 4/60 patients had bladder outflow obstruction secondary to adenocarcinoma of the prostate. 1/60 patients developed urosepsis, 1/60 patients developed a urinary tract infection and 1/60 patients required 3-way catheterization and irrigation due to haematuria. No patients required a blood transfusion. The mean IPSS at a mean follow-up interval of 19 months (range 15-28 months) was 5.1 (range 1-23). Postoperative maximum flow rate improved from 7.9 to 17.1 ml/s, and post-micturition residual volume decreased from 254 to 86 ml. ThuVaRP is safe and appears to have durable efficacy at intermediate follow-up. Copyright © 2011 S. Karger AG, Basel.

  10. A Small Molecule Inhibitor of Sarcomere Contractility Acutely Relieves Left Ventricular Outflow Tract Obstruction in Feline Hypertrophic Cardiomyopathy

    PubMed Central

    Stern, Joshua A.; Markova, Svetlana; Ueda, Yu; Kim, Jae B.; Pascoe, Peter J.; Evanchik, Marc J.; Green, Eric M.; Harris, Samantha P.

    2016-01-01

    Hypertrophic cardiomyopathy (HCM) is an inherited disease of the heart muscle characterized by otherwise unexplained thickening of the left ventricle. Left ventricular outflow tract (LVOT) obstruction is present in approximately two-thirds of patients and substantially increases the risk of disease complications. Invasive treatment with septal myectomy or alcohol septal ablation can improve symptoms and functional status, but currently available drugs for reducing obstruction have pleiotropic effects and variable therapeutic responses. New medical treatments with more targeted pharmacology are needed, but the lack of preclinical animal models for HCM with LVOT obstruction has limited their development. HCM is a common cause of heart failure in cats, and a subset exhibit systolic anterior motion of the mitral valve leading to LVOT obstruction. MYK-461 is a recently-described, mechanistically novel small molecule that acts at the sarcomere to specifically inhibit contractility that has been proposed as a treatment for HCM. Here, we use MYK-461 to test whether direct reduction in contractility is sufficient to relieve LVOT obstruction in feline HCM. We evaluated mixed-breed cats in a research colony derived from a Maine Coon/mixed-breed founder with naturally-occurring HCM. By echocardiography, we identified five cats that developed systolic anterior motion of the mitral valve and LVOT obstruction both at rest and under anesthesia when provoked with an adrenergic agonist. An IV MYK-461 infusion and echocardiography protocol was developed to serially assess contractility and LVOT gradient at multiple MYK-461 concentrations. Treatment with MYK-461 reduced contractility, eliminated systolic anterior motion of the mitral valve and relieved LVOT pressure gradients in an exposure-dependent manner. Our findings provide proof of principle that acute reduction in contractility with MYK-461 is sufficient to relieve LVOT obstruction. Further, these studies suggest that feline

  11. A Small Molecule Inhibitor of Sarcomere Contractility Acutely Relieves Left Ventricular Outflow Tract Obstruction in Feline Hypertrophic Cardiomyopathy.

    PubMed

    Stern, Joshua A; Markova, Svetlana; Ueda, Yu; Kim, Jae B; Pascoe, Peter J; Evanchik, Marc J; Green, Eric M; Harris, Samantha P

    2016-01-01

    Hypertrophic cardiomyopathy (HCM) is an inherited disease of the heart muscle characterized by otherwise unexplained thickening of the left ventricle. Left ventricular outflow tract (LVOT) obstruction is present in approximately two-thirds of patients and substantially increases the risk of disease complications. Invasive treatment with septal myectomy or alcohol septal ablation can improve symptoms and functional status, but currently available drugs for reducing obstruction have pleiotropic effects and variable therapeutic responses. New medical treatments with more targeted pharmacology are needed, but the lack of preclinical animal models for HCM with LVOT obstruction has limited their development. HCM is a common cause of heart failure in cats, and a subset exhibit systolic anterior motion of the mitral valve leading to LVOT obstruction. MYK-461 is a recently-described, mechanistically novel small molecule that acts at the sarcomere to specifically inhibit contractility that has been proposed as a treatment for HCM. Here, we use MYK-461 to test whether direct reduction in contractility is sufficient to relieve LVOT obstruction in feline HCM. We evaluated mixed-breed cats in a research colony derived from a Maine Coon/mixed-breed founder with naturally-occurring HCM. By echocardiography, we identified five cats that developed systolic anterior motion of the mitral valve and LVOT obstruction both at rest and under anesthesia when provoked with an adrenergic agonist. An IV MYK-461 infusion and echocardiography protocol was developed to serially assess contractility and LVOT gradient at multiple MYK-461 concentrations. Treatment with MYK-461 reduced contractility, eliminated systolic anterior motion of the mitral valve and relieved LVOT pressure gradients in an exposure-dependent manner. Our findings provide proof of principle that acute reduction in contractility with MYK-461 is sufficient to relieve LVOT obstruction. Further, these studies suggest that feline

  12. Erythrocyte creatine as a marker of intravascular hemolysis due to left ventricular outflow tract obstruction in hypertrophic cardiomyopathy.

    PubMed

    Kubo, Toru; Okumiya, Toshika; Baba, Yuichi; Hirota, Takayoshi; Tanioka, Katsutoshi; Yamasaki, Naohito; Sugiura, Tetsuro; Doi, Yoshinori L; Kitaoka, Hiroaki

    2016-03-01

    Erythrocyte creatine, a marker of erythrocyte age that increases with shortening of erythrocyte survival, has been reported to be a quantitative and reliable marker for intravascular hemolysis. We hypothesized that hemolysis could also occur due to intraventricular obstruction in patients with hypertrophic cardiomyopathy (HCM). The purpose of this study was to examine the presence of subclinical hemolysis and the relation between intravascular hemolysis and intraventricular pressure gradient (IVPG). We measured erythrocyte creatine in 92 HCM patients. Twelve patients had left ventricular outflow tract obstruction (LVOTO), 4 had midventricular obstruction (MVO), and the remaining 76 were non-obstructive. Erythrocyte creatine levels ranged from 0.92 to 4.36μmol/g hemoglobin. Higher levels of erythrocyte creatine were associated with higher IVPG (r=0.437, p<0.001). If erythrocyte creatine levels are high (≥1.8μmol/g hemoglobin), subclinical hemolysis is considered to be present. Half of LVOTO patients and no MVO patients showed high erythrocyte creatine levels. Although non-obstructive patients did not show significant intraventricular obstruction at rest, some showed high erythrocyte creatine levels. When LVOT-PG was measured during the strain phase of the Valsalva maneuver in 20 non-obstructive patients, 7 of those 20 patients showed LVOTO. In the 20 patients, there was no relation between erythrocyte creatine levels and LVOT-PG before the Valsalva maneuver (r=0.125, p=0.600), whereas there was a significant correlation between erythrocyte creatine and LVOT-PG provoked by the Valsalva maneuver (r=0.695, p=0.001). There is biochemical evidence of subclinical hemolysis in patients with HCM, and this hemolysis seems to be associated with LVOTO provoked by daily physical activities. Copyright © 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  13. Bladder outlet obstruction triggers neural plasticity in sensory pathways and contributes to impaired sensitivity in erectile dysfunction.

    PubMed

    Malykhina, Anna P; Lei, Qi; Chang, Shaohua; Pan, Xiao-Qing; Villamor, Antonio N; Smith, Ariana L; Seftel, Allen D

    2013-05-15

    Lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) are common problems in aging males worldwide. The objective of this work was to evaluate the effects of bladder neck nerve damage induced by partial bladder outlet obstruction (PBOO) on sensory innervation of the corpus cavernosum (CC) and CC smooth muscle (CCSM) using a rat model of PBOO induced by a partial ligation of the bladder neck. Retrograde labeling technique was used to label dorsal root ganglion (DRG) neurons that innervate the urinary bladder and CC. Contractility and relaxation of the CCSM was studied in vitro, and expression of nitric oxide synthase (NOS) was evaluated by Western blotting. Concentration of the sensory neuropeptides substance P (SP) and calcitonin gene-related peptide was measured by ELISA. Partial obstruction of the bladder neck caused a significant hypertrophy of the urinary bladders (2.5-fold increase at 2 wk). Analysis of L6-S2 DRG sections determined that sensory ganglia received input from both the urinary bladder and CC with 5-7% of all neurons double labeled from both organs. The contractile responses of CC muscle strips to KCl and phenylephrine were decreased after PBOO, followed by a reduced relaxation response to nitroprusside. A significant decrease in neuronal NOS expression, but not in endothelial NOS or protein kinase G (PKG-1), was detected in the CCSM of the obstructed animals. Additionally, PBOO caused some impairment to sensory nerves as evidenced by a fivefold downregulation of SP in the CC (P ≤ 0.001). Our results provide evidence that PBOO leads to the impairment of bladder neck afferent innervation followed by a decrease in CCSM relaxation, downregulation of nNOS expression, and reduced content of sensory neuropeptides in the CC smooth muscle. These results suggest that nerve damage in PBOO may contribute to LUTS-ED comorbidity and trigger secondary changes in the contraction/relaxation mechanisms of CCSM.

  14. MicroRNAs in Bladder Outlet Obstruction: Relationship to Growth and Matrix Remodelling.

    PubMed

    Ekman, Mari; Albinsson, Sebastian; Uvelius, Bengt; Swärd, Karl

    2016-10-01

    The discovery of microRNAs (miRNAs), which are ~22 nucleotide RNAs that inhibit protein synthesis in a sequence-specific manner and are present in a range of species, has born hope of new therapeutic strategies. miRNAs play important roles in development and disease, but they remain poorly studied in uropathologies beyond cancer. Here, we discuss biological functions of miRNAs in the lower urogenital tract. A special focus is on miRNAs that change in bladder outlet obstruction (BOO). This is a condition that affects nearly one third of all men over 60 years and that involves growth and fibrosis of the urinary bladder. Animal models of BOO, such as that in rat, have been developed, and they feature a massive 6-fold bladder growth over 6 weeks. Using microarrays, we have charted the miRNAs that change during the time course of this process and identified several with important modulatory roles. We discuss known and predicted functions of miR-1, miR-29, miR-30, miR-132/212, miR-204 and miR-221, all of which change in BOO. The majority of the miRNA-mediated influences in BOO are expected to favour growth. We also outline evidence that miR-29 represents a key effector molecule in a generic response to mechanical distension that is designed to counteract exaggerated organ deformation via effects on matrix deposition and stiffness. We conclude that miRNAs play important roles in bladder remodelling and growth and that they may be targeted pharmacologically to combat diseases of the lower urinary tract. © 2015 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).

  15. Acute outflow obstruction of hepatic veins in rabbits: quantitative analysis of hepatic perfusion with contrast-enhanced sonography.

    PubMed

    Kim, Kyoung Won; Kim, Pyo Nyun; Shin, Ji Hoon; Shin, Dong Ho; Jeong, Woo Kyoung; Won, Hyung Jin; Shin, Yong Moon; Lee, Won Jae; Lee, Moon Gyu; Song, Gi-Won; Hwang, Shin; Lee, Sung-Gyu

    2011-05-01

    To compare time-enhancement curve parameters of contrast-enhanced sonography in acute partial hepatic venous outflow obstruction with those of a baseline study. Contrast-enhanced sonography was performed in 11 rabbits with bolus administration of a sulfur hexafluoride contrast agent (0.1 mL/kg). After baseline scanning for 3 minutes, a 5.3F balloon catheter was placed into the left hepatic vein. Obstruction was artificially induced by 0.4-mL balloon inflation, and sonography was repeatedly performed thereafter. On images stored with 1-second intervals, 2 × 2-mm regions of interest were placed, and mean luminosity was measured. Time-enhancement curves were plotted, and contrast arrival times, peak enhancement values, peak enhancement times, 50% wash-out times, and 3-minute wash-out rates were obtained. Paired t tests were performed to evaluate the significance of differences in the parameters between baseline and obstruction. On baseline sonography, the median contrast arrival time, peak enhancement value, peak enhancement time, 50% wash-out time, and 3-minute wash-out rate were 6 (range, 4-8; mean ± SD, 5.9 ± 1.2) seconds, 188.5 (104.7-209.5; 178.4 ± 33.1) arbitrary units, 19 (14-27; 19.8 ± 4.1) seconds, 75 (60-101; 78.2 ± 13.9) seconds, and 89.7% (81.3%-95.1%; 88.4% ± 4.9%), respectively. With obstruction, those values were 7 (5-12; 6.9 ± 2.3) seconds, 202.8 (98.2-215.1; 186.0 ± 39.3) arbitrary units, 31 (17-59; 32 ± 11.6) seconds, 101 (47-136; 96.2 ± 23.6) seconds, and 79.2% (66.2%-88.8%; 79.1% ± 7.6%). Compared with baseline, the peak enhancement time was significantly delayed from 19 to 31 seconds (P = .0027), 50% wash-out time significantly delayed from 75 to 101 seconds (P = .0209), and 3-minute wash-out rate significantly decreased from 89.7% to 79.2% (P < .0001) with obstruction, but there were no significant differences in contrast arrival times and peak enhancement values (P = .0756 and .2179). Contrast-enhanced sonography can provide

  16. Medical management of overactive bladder

    PubMed Central

    Ubee, Sarvpreet S.; Manikandan, Ramaswamy; Singh, Gurpreet

    2010-01-01

    Overactive bladder (OAB), as defined by the International Continence Society, is characterized by a symptom complex including urinary urgency with or without urge incontinence, usually associated with frequency and nocturia. OAB syndrome has an incidence reported from six European countries ranging between 12-17%, while in the United States; a study conducted by the National Overactive Bladder Evaluation program found the incidence at 17%. In Asia, the prevalence of OAB is reported at 53.1%. In about 75%, OAB symptoms are due to idiopathic detrusor activity; neurological disease, bladder outflow obstruction (BOO) intrinsic bladder pathology and other chronic pelvic floor disorders are implicated in the others. OAB can be diagnosed easily and managed effectively with both non-pharmacological and pharmacological therapies. The first-line treatments are lifestyle interventions, bladder training, pelvic floor muscle exercises and anticholinergic drugs. Antimuscarinics are the drug class of choice for OAB symptoms; with proven efficacy, and adverse event profiles that differ somewhat. PMID:20877608

  17. Factors determining the amount of residual urine in men with bladder outlet obstruction: Could it be a predictor for bladder contractility?

    PubMed

    Elmissiry, Mostafa M; Ali, Amr G; Abulfotooh, Ahmed; Moussa, Ahmed A; Ali, Gaber A

    2014-09-01

    To determine from urodynamic data what causes an increased postvoid residual urine volume (PVR) in men with bladder outlet obstruction (BOO), urethral resistance or bladder failure, and to determine how to predict bladder contractility from the PVR. We analysed retrospectively the pressure-flow studies (PFS) of 90 men with BOO. Nine patients could not void and the remaining 81 were divided into three groups, i.e. A (30 men, PVR < 100 mL), B (30 men, PVR 100-450 mL) and C (21 men, PVR > 450 mL). The division was made according to a receiver operating characteristic curve, showing that using a threshold PVR of 450 mL had the best sensitivity and specificity for detecting the start of bladder failure. The filling phase showed an increase in bladder capacity with the increase in PVR and a significantly lower incidence of detrusor overactivity in group C. The voiding phase showed a significant decrease in voided volume and maximum urinary flow rate (Q max) as the PVR increased, while the urethral resistance factor (URF) increased from group A to B to C. The detrusor pressure at Q max (PdetQ max) and opening pressure were significantly higher in group B, which had the highest bladder contractility index (BCI) and longest duration of contraction. Group C had the lowest BCI and the lowest PdetQ max. In men with BOO, PVR results from increasing outlet resistance at the start and up to a PVR of 450 mL, where the bladder reaches its maximum compensation. At volumes of >450 mL, both the outlet resistance and bladder failure are working together, leading to detrusor decompensation.

  18. Papillary muscle insertion directly into the anterior mitral leaflet in hypertrophic cardiomyopathy, its identification and cause of outflow obstruction by cardiac magnetic resonance imaging, and its surgical management.

    PubMed

    Rowin, Ethan J; Maron, Barry J; Lesser, John R; Rastegar, Hassan; Maron, Martin S

    2013-06-01

    This case presents an uncommon but important mechanism of muscular left ventricular outflow obstruction in hypertrophic cardiomyopathy due to anomalous and direct papillary muscle insertion into the anterior mitral leaflet, a finding reliably identified clinically by cardiac magnetic resonance imaging. The identification of this left ventricular outflow tract morphology is important before invasive ventricular septal reduction therapy because it dictates a specific surgical strategy. These findings further support the role of cardiac magnetic resonance imaging in the early evaluation of hypertrophic cardiomyopathy patients.

  19. The Long-term Effect of Superficial Bladder Neck Incision on Ejaculation and Incontinence in Boys with Primary and Secondary Bladder Neck Obstruction.

    PubMed

    Hennus, Pauline M L; Hoenjet, Esther; Kieft, Jan H; de Jong, Tom P V M; de Kort, Laetitia M O

    2017-01-01

    Superficial bladder neck incision (SBNI) is controversial at young age, with retrograde ejaculation after puberty as main concern. The aim of the study is to investigate the long-term effect of SBNI on ejaculation and incontinence in boys with primary and secondary bladder neck obstruction (BNO). In boys with infravesical obstruction, SBNI was performed in case of a persistent BNO after earlier desobstruction or in case of primary severely obstructive bladder neck. SBNI was performed with a diathermy hook, always superficially (2-3 mm) and unilaterally at 7 O'clock. Males that had SBNI during childhood after posterior urethral valve incision or relief of other obstruction between 1986 and 2003 were included. Evaluation was done by International Continence Society male sex questionnaire, International Prostate Symptom Score, developmental International Consultation Modular Questionnaire on Urinary Incontinence, frequency volume chart, and uroflowmetry. Of 79 traceable patients, 40 (50.6%) participated. Of these, 37 (92.5%) completed all questionnaires and 28 (70%) performed uroflowmetry. Median age at SBNI was 4.7 years [interquartile range (IQR) 0.6-8.5] and was 19.6 years (IQR 17.3-20.9) at follow-up. All men had antegrade ejaculation, 4/37 (10.8%) reported possibly reduced ejaculatory volume. Eight (22%) had moderate lower urinary tract symptoms and two (5.4%) had moderate incontinence. Median maximum flow rate was 30.1 mL/s (IQR 24.4-42.6). SBNI in boys with severe infravesical obstruction can be done safely with preservation of antegrade ejaculation and no additional lower urinary tract dysfunction.

  20. Detection of Subpubic Tumor Causing Bladder Outlet Obstruction by 3D Perineal Ultrasound.

    PubMed

    Albrich, S; Steetskamp, J; Rommens, K; Porta, S; Battista, M; Hoffmann, G; Skala, C

    2015-07-01

    This case report shows that 3D perineal ultrasound can be superior to clinical examination and routine 2D perineal ultrasound in the detection of an unusual subpubic tumor. A 73-year-old female patient was referred to our urogynecological outpatient unit complaining of over-active bladder symptoms and voiding dysfunction for 3 years. Gynecological examination found no signs of pelvic organ prolapse or abnormality in the vaginal cavity. Routine 2D perineal ultrasound showed substantial residual urine (ca. 300 ml on catheter) and limited bladder neck mobility, but no signs of pelvic organ prolapse. Use of standardized 3D perineal ultrasound revealed a 24 × 26 × 32 mm spherical, hypoechoic tumor below the pubic symphysis between the distal urethra and the pubic bones. This structure was mistaken for the pubic symphysis in the midline on 2D ultrasound performed earlier. At surgery, the tumor was completely excised through a vaginal incision between the urethra and the pubic symphysis. After an uneventful postoperative recovery the patient developed de-novo stress urinary incontinence, which was corrected successfully by the insertion of a retropubic tension-free suburethral sling after an interval of 8 weeks. After a further follow-up of 8 weeks the patient reported well-being, urinary continence and no voiding dysfunction; no abnormalities were found on examination. In conclusion, 3D perineal ultrasound is a useful additional tool for the diagnostic workup of bladder outlet obstruction.

  1. Effect of silodosin, a selective α(1A)-adrenoceptor antagonist, on voiding behavior and bladder blood flow in a rat model of bladder outlet obstruction.

    PubMed

    Goi, Yoshiaki; Tomiyama, Yoshitaka; Yokoyama, Ayaka; Tatemichi, Satoshi; Maruyama, Kazuyasu; Kobayashi, Mamoru; Yamaguchi, Osamu

    2015-10-05

    This study was performed to investigate the effects of silodosin (selective α1A-adrenoceptor antagonist) on bladder blood flow (BBF) and bladder function in a rat model of bladder outlet obstruction (BOO) and to determine the expression of α1-adrenoceptor subtype mRNA in human and rat bladder microvessels. BOO was produced by partial ligature of the proximal urethra, which was maintained for 2 weeks. The BOO rats received either silodosin at a rate of 0.3mg/kg/day or vehicle subcutaneously via an osmotic pump for 2 weeks after BOO surgery. A metabolic cage study was performed in conscious animals. BBF was measured using a Laser Speckle Blood Flow Imager. Urinary levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG) and nerve growth factor (NGF) were measured. Immunohistological examinations of nerve distribution and NGF expression in the rat bladder were conducted. The expression of each α1-adrenoceptor subtype mRNA in human and rat bladder microvessels was determined by in situ hybridization. Silodosin ameliorated the increase in voiding frequency and decrease in mean voided volume in BOO rats in the metabolic cage study. Silodosin also abrogated the decrease in BBF in BOO rats. The levels of 8-OHdG and NGF in BOO rats were significantly decreased by administration of silodosin. Silodosin prevented the decrease in nerve distribution and increase in NGF expression. Human and rat bladder microvessels showed expression of all α1-adrenoceptor subtype mRNAs. The results presented here suggest that silodosin improves voiding behavior in rat models with BOO by inducing recovery of BBF.

  2. Side-to-side cavocavostomy with an endovascular stapler: Rescue technique for severe hepatic vein and/or inferior vena cava outflow obstruction after liver transplantation using the piggyback technique.

    PubMed

    Quintini, Cristiano; Miller, Charles M; Hashimoto, Koji; Philip, Ding; Uso, Teresa Diago; Aucejo, Federico; Kelly, Dympna; Winans, Charles; Eghtesad, Bijan; Vogt, David; Fung, John

    2009-01-01

    Venous outflow obstruction is a rare but potentially lethal complication after orthotopic liver transplantation (OLT) with the "piggyback" technique. Therapeutic options include angioplasty with or without stent placement, surgical reconstruction of the venous anastomosis, and retransplantation. Surgical options are technically very challenging and the outcomes discouraging. We describe here two cases of venous outflow obstruction in recipients of piggyback liver grafts, one involving both the vena cava and hepatic veins and the other affecting only hepatic vein outflow. Both patients were treated successfully with side-to-side cavo-cavostomy using an endovascular (endo-GIA) stapler. This novel technique is fast and effective in resolving the outflow obstruction. Copyright 2008 AASLD.

  3. Resistive index of prostate capsular arteries: a newly identified parameter to diagnose and assess bladder outlet obstruction in patients with benign prostatic hyperplasia.

    PubMed

    Zhang, Xuefeng; Li, Gang; Wei, Xuedong; Mo, Xiaodong; Hu, Linkun; Zha, Yueqin; Hou, Jianquan

    2012-09-01

    We evaluated the association of the resistive index of the prostate capsular arteries and bladder outlet obstruction severity in men with benign prostatic hyperplasia. A total of 74 patients histologically diagnosed with benign prostatic hyperplasia were ultimately enrolled in this prospective study. Urodynamics were performed by a urologist to determine bladder outlet obstruction. Baseline parameters measured in patients with benign prostatic hyperplasia were the prostate capsular artery resistive index, International Prostate Symptom Score, quality of life score, total prostate and transition zone volume, and the transition zone index. ROC curves were produced to calculate the ROC AUC and evaluate the diagnostic performance of the prostate capsular artery resistive index, International Prostate Symptom Score, obstructive symptoms, total prostate and transition zone volume, and the transition zone index for bladder outlet obstruction. Significant difference between patients with and without bladder outlet obstruction was observed in the resistive index, which showed the highest coefficient with the degree of obstruction (r = 0.712, p <0.0001). At a cutoff of 0.69 the resistive index distinguished patients with and without bladder outlet obstruction with 78% sensitivity and 86.4% specificity. The prostate capsular artery resistive index had the maximum AUC of 0.823. The prostate capsular artery resistive index is significantly higher in patients with benign prostatic hyperplasia related bladder outlet obstruction than in those without such obstruction. The resistive index might serve as a novel indicator to diagnose and assess bladder outlet obstruction in patients with benign prostatic hyperplasia. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  4. Increased susceptibility of estrogen-induced bladder outlet obstruction in a novel mouse model.

    PubMed

    Tam, Neville Ngai-Chung; Zhang, Xiang; Xiao, Hong; Song, Dan; Levin, Linda; Meller, Jarek; Ho, Shuk-Mei

    2015-05-01

    Disorders of the prostate and lower urinary tract are common in elderly men. We investigated the role of metallothionein-1 (MT1) in prostate carcinogenesis by generating a prostate-specific, MT1-expressing mouse. Unexpectedly, genomic analyses revealed that a 12.1-kb genomic region harboring several conserved noncoding elements was unintentionally deleted, upstream of the transgene integration site in the mouse, which we named it 12.1ΔMT1. Male 12.1ΔMT1 mice chronically treated with testosterone (T) plus 17β-estradiol (E2) to induce prostate cancer exhibited no evidence of precancerous or cancerous lesions. Instead, most of them exhibited a bladder outlet obstruction (BOO) phenotype not observed in treated wild-type (WT) mice. Thus, we hypothesized that 12.1ΔMT1 is a novel model for studying the hormonal requirement for BOO induction. Adult male 12.1ΔMT1 and WT mice were treated with T, E2, bisphenol A (BPA), T+E2, or T+BPA for up to 6 months. Histologic and immunohistochemical analysis of the prostate, bladder, and urethra were performed. No significant prostate pathologies were observed in WT or 12.1ΔMT1 mice treated with any of the hormone regimens. As expected, prostatic regression occurred in all E2-treated animals (WT and 12.1ΔMT1). Of great interest, despite a small prostate, 100% of E2-treated 12.1ΔMT1 mice, but only 40% of E2-treated WT mice, developed severe BOO (P<0.01). In contrast, T+E2 treatment was less effective than E2 treatment in inducing severe BOO in 12.1ΔMT1 mice (68%, P<0.05) and was completely ineffective in WT animals. Similarly, T, BPA, and T+BPA treatments did not induce BOO in either WT or 12.1ΔMT1 mice. The BOO pathology includes a thinner detrusor wall, narrowing of bladder neck and urethral lumen, and basal cell hyperplasia in the bladder body and urethra. These findings indicate that 12.1ΔMT1 mice exhibit enhanced susceptibility to E2-induced BOO that is independent of prostate enlargement but that is attenuated by the

  5. Intentional Laceration of the Anterior Mitral Valve Leaflet to Prevent Left Ventricular Outflow Tract Obstruction During Transcatheter Mitral Valve Replacement

    PubMed Central

    Khan, Jaffar M.; Rogers, Toby; Schenke, William H.; Mazal, Jonathan R.; Faranesh, Anthony Z.; Greenbaum, Adam B.; Babaliaros, Vasilis C.; Chen, Marcus Y.; Lederman, Robert J.

    2017-01-01

    OBJECTIVES The authors propose a novel transcatheter transection of the anterior mitral leaflet to prevent iatrogenic left ventricular outflow tract (LVOT) obstruction during transcatheter mitral valve replacement (TMVR). BACKGROUND LVOT obstruction is a life-threatening complication of TMVR caused by septal displacement of the anterior mitral leaflet. METHODS In vivo procedures in swine were guided by biplane x-ray fluoroscopy and intracardiac echocardiography. Retrograde transaortic 6-F guiding catheters straddled the anterior mitral leaflet. A stiff 0.014-inch guidewire with polymer jacket insulation was electrified and advanced from the LVOT, through the A2 leaflet base, into the left atrium. The wire was snared and externalized, forming a loop that was energized and withdrawn to lacerate the anterior mitral leaflet. RESULTS The anterior mitral leaflet was successfully lacerated in 7 live and 1 post-mortem swine under heparinization. Lacerations extended to 89 ± 19% of leaflet length and were located within 0.5 ± 0.4 mm of leaflet centerline. The chordae were preserved and retracted the leaflet halves away from the LVOT. LVOT narrowing after benchtop TMVR was significantly reduced with intentional laceration of the anterior mitral leaflet to prevent LVOT obstruction than without (65 ± 10% vs. 31 ± 18% of pre-implantation diameter, p < 0.01). The technique caused mean blood pressure to fall (from 54 ± 6 mm Hg to 30 ± 4 mm Hg, p < 0.01), but blood pressure remained steady until planned euthanasia. No collateral tissue injury was identified on necropsy. CONCLUSIONS Using simple catheter techniques, the anterior mitral valve leaflet was transected. Cautiously applied in patients, this strategy can prevent anterior mitral leaflet displacement and LVOT obstruction caused by TMVR. PMID:27609260

  6. Dynamic left ventricular outflow tract obstruction secondary to hypovolemia in a German Shepard dog with splenic hemangiosarcoma

    PubMed Central

    AOKI, Takuma; SUNAHARA, Hiroshi; SUGIMOTO, Keisuke; ITO, Tetsuro; KANAI, Eiichi; NEO, Sakurako; FUJII, Yoko; WAKAO, Yoshito

    2015-01-01

    Dynamic left ventricular outflow tract obstruction (DLVOTO) is a common condition in cats and humans. In this case report, a dog is described with DLVOTO secondary to severe intra-abdominal hemorrhage caused by a hemangiosarcoma. The dog was a 9-year-old, 35.7-kg, spayed female German Shepard dog that presented with a history of tachypnea and collapse. A Levine II/VI systolic murmur was present at the heart base. Abdominal ultrasonography revealed a splenic mass and a large amount of ascites. Echocardiography showed a reduced left ventricular diameter and an increased aortic velocity caused by systolic anterior motion (SAM) of the mitral valve apparatus. The heart murmur and the SAM were resolved after treatment including a splenectomy and a blood transfusion. PMID:25924797

  7. 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

  8. APICAL LEFT VENTRICULAR-ABDOMINAL AORTIC COMPOSITE CONDUITS FOR LEFT VENTRICULAR OUTFLOW OBSTRUCTIONS

    PubMed Central

    Cooley, Denton A.; Norman, John C.

    1978-01-01

    Certain problems related to the left ventricular outflow tract are not amenable to conventional surgical methods, but may be solved with the creation of a double outlet left ventricle by using a composite rigid pyrolite left ventricular apex outlet prosthesis and a fabric valve-containing conduit. Low porosity woven Dacron tube grafts are used for the conduit. Twenty-three patients who have undergone apico-aortic bypass with this conduit are reported here, with gratifying results in eighteen. PMID:15216062

  9. Right Ventricular Outflow Tract Obstruction Due to Immunoglobulin G4-Related Disease.

    PubMed

    Ishida, Masaru; Sakaguchi, Taichi; Miyagawa, Shigeru; Nishi, Hiroyuki; Yoshikawa, Yasushi; Fukushima, Satsuki; Kawamura, Ai; Ueno, Takayoshi; Ishibashi-Ueda, Hatsue; Sawa, Yoshiki

    2017-03-01

    A 64-year-old man with extensive tumorous infiltration of the pulmonary valve underwent partial resection of a tumor of the right ventricular outflow tract and replacement of the affected valve. A diagnosis of immunoglobulin-G4 related disease of the heart was made based on the immunohistologic findings. One year after the surgical resection, growth of the tumorous mass was observed, and steroid therapy was initiated. He had no sign of tumor progression four years after the steroid therapy.

  10. Low frequency of V617F mutation in JAK2 gene in Indian patients with hepatic venous outflow obstruction and extrahepatic portal venous obstruction.

    PubMed

    Rai, Praveer; Kumar, Pankaj; Mishra, Swapnil; Aggarwal, Rakesh

    2016-09-01

    Hepatic venous outflow tract obstruction (HVOTO) and extrahepatic portal venous obstruction (EHPVO) are important causes of portal hypertension and related complications in India. Both these conditions result from splanchnic venous thrombosis. In recent years, a V617F somatic mutation in Janus kinase 2 (JAK2) gene which is highly specific for myeloproliferative disorders has been detected in 40 % to 50 % and 30 % to 35 % of Western patients with HVOTO and EHPVO, respectively. However, data on this mutation in these conditions from Asian countries are limited. We looked for JAK2 V617F mutation in Indian patients with HVOTO (n = 40, median age 31 [range 17-51] years, 21 female) and EHPVO (n = 50, median age 23 [15-70] years, 25 female) by using two separate methods. Both the methods involved polymerase chain reaction using allele-specific primers. Positive results on one or both of these techniques were confirmed using DNA sequencing. None of the 40 patients with HVOTO and only 1 of 50 patients with EHPVO was found to have JAK2 V617F mutation. In the one patient who was found to have this mutation, both the PCR methods and DNA sequencing showed positive results. Hypercoagulability associated with JAK2 V617F mutation and associated chronic myeloproliferative disorders was not a major cause of HVOTO and EHPVO in this population.

  11. An evaluation of range gated pulsed Doppler echocardiography for detecting pulmonary outflow tract obstruction in d-transposition of the great vessels.

    PubMed

    Areias, J C; Goldberg, S J; Spitaels, S E; de Villeneuve, V H

    1978-10-01

    The aim of this study was to determine the accuracy of range gated pulsed Doppler (RGPD) echocardiography for detecting obstruction to the pulmonary outflow tract in children with d-transposition of the great vessels (d-TGV). Twenty-one children were randomly selected for those available with d-TGV and were studied by precordial and suprasternal RGPD echocardiography. Three were excluded, leaving a population of 18 subjects. The exclusive criterion used to judge the RGPD results was the output of the time interval histogram (TIH). Coherence of the TIH was considered to represent laminar flow. Dispersion of the TIH was considered evidence of flow disturbance and obstruction to the outflow tract. With the range gating feature, the first site of disturbance could be localized. Information was handled by a technique that decreased bias. RGPD results were then compared to diagnoses of the outflow tract established at cardiac catheterization or operation. Comparison of these results indicated that all seven children with obstruction were correctly identified by RGPD study, and the level of the first obstruction was correctly identified. With one exception, all children without pulmonary obstruction were correctly identified by the examination.

  12. Bidirectional Glenn shunt as an adjunct to surgical repair of congenital heart disease associated with pulmonary outflow obstruction: relevance of the fluid pressure drop-flow relationship.

    PubMed

    Ascuitto, Robert; Ross-Ascuitto, Nancy; Wiesman, Joshua; Deleon, Serafin

    2008-09-01

    A bidirectional Glenn shunt (BGS) was successfully incorporated into a two-ventricle repair for 10 patients (age, 3-17 years) who had congenital heart disease associated with severe pulmonary outflow obstruction. The BGS was used to volume-unload the pulmonary ventricle faced with residual outflow obstruction, thereby avoiding the need for insertion of a ventricle-to-pulmonary artery conduit. Transthoracic Doppler flow velocity analysis was used to determine transpulmonary peak systolic pressure drops as a measure of obstruction. Preoperative values ranged from 70 to 100 mmHg, and postoperative values ranged from less than 10 to 16 mmHg. At this writing, all patients are doing well 15 to 52 months after surgery. To gain further insight into the reduced pressure drop that may be achieved by decreasing flow rate across obstruction, a computer-based description of fluid flow was used to simulate blood traversing circumferentially narrowed passages. Overall pressure drops and associated flow energy losses were determined from numeric solutions (using finite-element analysis) to the Navier-Stokes equations for the proposed fluid reactions. Pressure drops and flow energy losses were found to decrease dramatically as flow rate was progressively reduced. For selected patients, a BGS can be an effective adjunct to the surgical treatment of pulmonary outflow obstruction. This approach avoids the use of a ventricle-to-pulmonary artery conduit, and thus the inevitable need in most patients for reoperations because of somatic growth, conduit failure, or both.

  13. Review of invasive urodynamics and progress towards non-invasive measurements in the assessment of bladder outlet obstruction

    PubMed Central

    Griffiths, C. J.; Pickard, R. S.

    2009-01-01

    Objective: This article defines the need for objective measurements to help diagnose the cause of lower urinary tract symptoms (LUTS). It describes the conventional techniques available, mainly invasive, and then summarizes the emerging range of non-invasive measurement techniques. Methods: This is a narrative review derived form the clinical and scientific knowledge of the authors together with consideration of selected literature. Results: Consideration of measured bladder pressure urinary flow rate during voiding in an invasive pressure flow study is considered the gold standard for categorization of bladder outlet obstruction (BOO). The diagnosis is currently made by plotting the detrusor pressure at maximum flow (pdetQmax) and maximum flow rate (Qmax) on the nomogram approved by the International Continence Society. This plot will categorize the void as obstructed, equivocal or unobstructed. The invasive and relatively complex nature of this investigation has led to a number of inventive techniques to categorize BOO either by measuring bladder pressure non-invasively or by providing a proxy measure such as bladder weight. Conclusion: Non-invasive methods of diagnosing BOO show great promise and a few have reached the stage of being commercially available. Further studies are however needed to validate the measurement technique and assess their worth in the assessment of men with LUTS. PMID:19468436

  14. Pulmonary outflow tract obstruction in fetuses with complex congenital heart disease: predicting the need for neonatal intervention.

    PubMed

    Quartermain, M D; Glatz, A C; Goldberg, D J; Cohen, M S; Elias, M D; Tian, Z; Rychik, J

    2013-01-01

    To identify prenatal echocardiographic markers that could predict the need for neonatal intervention in fetuses with right ventricular outflow tract obstruction. This was a retrospective study of 52 fetuses with right ventricular outflow tract obstruction. Echocardiograms were evaluated for fetuses with either two-ventricle anatomy with a large ventricular septal defect or single-ventricle anatomy. Fetuses with pulmonary atresia were excluded. Parameters were compared between groups that did and did not require an intervention at age < 30 days. Fifty-two fetuses were studied; 20 (38%) underwent neonatal intervention and 32 (62%) did not. The most common diagnosis was tetralogy of Fallot (n = 32). Fetuses with two ventricles that required an intervention had lower pulmonary valve diameter Z-score (PV-Z-score) (-4.8 ± 2.1 vs. -2.6 ± 1.1; P = 0.0002) and lower pulmonary valve to aortic valve annular diameter ratio (PV/AoV) (0.53 ± 0.15 vs. 0.66 ± 0.1; P = 0.003). Using a PV/AoV ratio of < 0.6 or a PV-Z-score of < -3 at final echocardiographic examination was highly sensitive (92%) but poorly specific (50%), whereas classifying direction of flow in the ductus arteriosus as either normal (all pulmonary-to-aorta) or abnormal (aorta-to-pulmonary or bidirectional) was both highly sensitive (100%) and specific (95%) for predicting the need for a neonatal intervention. Parameters for the single-ventricle cohort did not reach statistical significance. Analysis of the pulmonary outflow tract and ductus arteriosus flow in the fetus with complex congenital heart disease can aid in identifying those that will require a neonatal intervention to augment pulmonary blood flow. This has important implications for the planning of delivery strategies. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.

  15. A Novel Intraurethral Device Diagnostic Index to Classify Bladder Outlet Obstruction in Men with Lower Urinary Tract Symptoms

    PubMed Central

    Reis, Leonardo O.; Barreiro, Guilherme C.; Prudente, Alessandro; Silva, Cleide M.; Bassani, José W. M.; D'Ancona, Carlos A. L.

    2009-01-01

    Objectives. Using a urethral device at the fossa navicularis, bladder pressure during voiding can be estimated by a minimal invasive technique. This study purposes a new diagnostic index for patients with lower urinary tract symptoms (LUTSs). Methods. Fifty one patients presenting with LUTSs were submitted to a conventional urodynamic and a minimal invasive study. The results obtained through the urethral device and invasive classic urodynamics were compared. The existing bladder outlet obstruction index (BOOI) equation that classifies men with LUTSs was modified to allow minimal invasive measurement of isovolumetric bladder pressure in place of detrusor pressure at maximum urine flow. Accuracy of the new equation for classifying obstruction was then tested in this group of men. Results. The modified equation identified men with obstruction with a positive predictive value of 68% and a negative predictive value of 70%, with an overall accuracy of 70%. Conclusions. The proposed equation can accurately classify over 70% of men without resorting to invasive pressure flow studies. We must now evaluate the usefulness of this classification for the surgical treatment of men with LUTSs. PMID:19125194

  16. Does uroflowmetry parameter facilitate discrimination between detrusor underactivity and bladder outlet obstruction?

    PubMed Central

    Lee, Kwon Soo; Song, Phil Hyun

    2016-01-01

    Purpose Though urodynamic study (UDS) is the current established standard to distinguish between detrusor underactivity (DU) and bladder outlet obstruction (BOO), concerns of patient discomfort and potential complications of catheterization deters its use. We inspected clinical variables to discriminate between DU and BOO in uroflowmetry, which can be more easily performed in clinical practice. Materials and Methods Total 240 men who both underwent UDS and uroflowmetry were reviewed. The patients were divided into 2 groups by a single experienced urologist based on UDS outcome; DU (n=111) and BOO (n=129). From uroflowmetry, 5 variables including maximal flow rate (Qmax), average flow rate (Qave), voiding volume (VV), postvoid residual urine (PVR), and value of Qmax minus Qave (DeltaQ) was obtained. Multivariable analysis including receiver operating characteristic (ROC) curve analysis was performed to identify the important diagnostic predictors. Results The mean age (±standard deviation) was 65.3±9.2 years. Except Qave, all uroflowmetry components were significantly different between DU and BOO groups. DeltaQ was smaller in DU group (8.71 mL/s vs. 5.26 mL/s, p<0.001). By logistic regression analysis, DeltaQ (Exp(B)=0.648, p<0.001) and PVR (Exp(B)=1.009, p<0.001) significantly discriminate DU and BOO diagnosis. In diagnosing DU using a single variable, the area under the curve of ROC from DeltaQ (0.806) was significantly higher than that from Qmax (0.763, p=0.0126) and Qave (0.574, p<0.0001). Conclusions Our findings suggest that DeltaQ is a novel predictor capable of discriminating DU from BOO in men with obstructive lower urinary tract symptom. PMID:27847918

  17. Transcatheter balloon dilation for recurrent right ventricular outflow tract obstruction following valve-sparing repair of tetralogy of Fallot.

    PubMed

    Gellis, Laura; Banka, Puja; Marshall, Audrey; Emani, Sitaram; Porras, Diego

    2015-10-01

    Valve-sparing repair in patients with tetralogy of Fallot (TOF) carries the risk of residual or recurrent right ventricular outflow tract (RVOT) obstruction, which is often treated with transcatheter balloon dilation (BD). The outcomes and associated complications of BD of the RVOT in this scenario remain unknown. Retrospective review of the records of the Department of Cardiology at Boston Children's Hospital from 2000 to 2013 was performed. 34 patients had initial valve-sparing repair of tetralogy of Fallot followed by BD of the RVOT during the study period. Following BD, the RVOT gradient decreased from a median of 43 mm Hg (range 13 to 79 mm Hg) to 28 mm Hg (range 0 to 73 mm Hg) (P < 0.001). Freedom from reintervention was 64% at 1 year and 46% at 3 years. Trivial to mild PR pre-BD was present in 56% (n = 19) of patients and decreased to 37% (n = 11) post-BD. Exclusively valvar obstruction was associated with a longer freedom from reintervention (P = 0.05), while a ratio of RV pressure to aortic systolic pressure pre-BD of >1 and a final RVOT gradient of ≥40 post-BD were associated with shorter freedom from reintervention (P < 0.001). BD in patients with recurrent RVOT obstruction following valve-sparing repair of TOF acutely reduces the RVOT gradient, but commonly results in increased PR and is associated with a high reintervention rate. Patients with stenosis solely at the level of the valve had a better response to this type of intervention. © 2015 Wiley Periodicals, Inc.

  18. Characterization of miRNA-regulated networks, hubs of signaling, and biomarkers in obstruction-induced bladder dysfunction

    PubMed Central

    Kiss, Bernhard; Moltzahn, Felix; Keller, Irene; Rehrauer, Hubert; Fournier, Catharine Aquino; Burkhard, Fiona C.

    2017-01-01

    Bladder outlet obstruction (BOO) induces significant organ remodeling, leading to lower urinary tract symptoms accompanied by urodynamic changes in bladder function. Here, we report mRNA and miRNA transcriptome sequencing of bladder samples from human patients with different urodynamically defined states of BOO. Patients’ miRNA and mRNA expression profiles correlated with urodynamic findings. Validation of RNA sequencing results in an independent patient cohort identified combinations of 3 mRNAs (NRXN3, BMP7, UPK1A) and 3 miRNAs (miR-103a-3p, miR-10a-5p, miR-199a-3p) sufficient to discriminate between bladder functional states. All BOO patients shared cytokine and immune response pathways, TGF-β and NO signaling pathways, and hypertrophic PI3K/AKT signaling pathways. AP-1 and NFkB were dominant transcription factors, and TNF-α was the top upstream regulator. Integrated miRNA-mRNA expression analysis identified pathways and molecules targeted by differentially expressed miRNAs. Molecular changes in BOO suggest an increasing involvement of miRNAs in the control of bladder function from the overactive to underactive/acontractile states. PMID:28138557

  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. High left ventricular outflow tract gradient: Aortic stenosis, obstructive hypertrophic cardiomyopathy or both?

    PubMed

    Almeida, Inês; Caetano, Francisca; Trigo, Joana; Mota, Paula; Marques, António Leitão

    2015-05-01

    The authors report the case of a patient diagnosed with both hypertrophic cardiomyopathy and aortic stenosis. Due to clinical deterioration, additional investigation was performed, and a high left ventricular outflow tract gradient was identified. Correct identification of the condition causing the symptoms was challenging, and involved several imaging techniques, the contribution of transesophageal echocardiography being crucial. The final diagnosis of severe aortic stenosis led to successful valve replacement surgery. The presence of these two conditions in the same patient has been documented, although it is uncommon. This association poses particular diagnostic and therapeutic challenges, which are discussed in this paper. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  1. Accessory Mitral Valve Leaflet Causing Severe Left Ventricular Outflow Tract Obstruction in a Preterm Neonate with a Partial Atrioventricular Septal Defect

    PubMed Central

    Fraser, Charles D.; Seery, Thomas J.

    2016-01-01

    Atrioventricular septal defects represent a class of congenital cardiac malformations that vary in presentation and management strategy depending upon the severity of the particular lesions present. We present the case of a premature neonate who had a partial atrioventricular septal defect and an accessory mitral (or left atrioventricular) valve leaflet. The latter caused severe left ventricular outflow tract obstruction and severely depressed left ventricular function. We found only one other report of this atrioventricular valve abnormality in association with atrioventricular septal defect. To our knowledge, our patient (at a body weight of 1,800 g) is the smallest to survive corrective surgery of an accessory mitral valve leaflet with severe left ventricular outflow tract obstruction. In addition to our patient's case, we discuss the relevant medical literature. PMID:28100980

  2. Aspergillus endocarditis: a case of near complete left ventricular outflow obstruction

    PubMed Central

    Attia, Rizwan Q.; Nowell, Justin L.; Roxburgh, James C.

    2012-01-01

    A 60-year old woman presented with dyspnoea and fatigue. She was frail and cachectic (BMI 17.5) with a pancytopenia. Previously she had received chemotherapy for chronic lymphatic leukaemia. She relapsed one year ago necessitating a reduced intensity conditioning allogeneic haematopoietic cell transplantation. Subsequently, graft versus host disease required high-dose immunosuppressants. Computerized tomography on admission showed bilateral lung nodules and a suspicious cardiac mass. Bronchial biopsies demonstrated abundant hypae consistent with Aspergillus fumigatus infection. Echocardiography demonstrated a large fungus ball attached to the right coronary cusp of the aortic valve with near complete obliteration of the left ventricular outflow tract. Due to the high risk of embolization this was resected under cardiopulmonary bypass. The mass was attached subvalvularly to the ventricular septal free wall and eroding through it. It peeled off leaving intact aortic leaflets. Unresectable fungal deposits were discovered on the interventricular septum, the left ventricle free wall and posterior aortic wall. High-dose systemic antifungal therapy (Voriconazole and Amphoteracin B) was given for 4 months. After discharge she remained well till a 4-month follow-up, after which she eventually succumbed to her disease. We discuss the clinical difficulties in managing patients with fungal infective endocarditis and present a brief review of cardiac aspergillosis management. PMID:22374293

  3. Association of common variants in ERBB4 with congenital left ventricular outflow tract obstruction defects.

    PubMed

    McBride, Kim L; Zender, Gloria A; Fitzgerald-Butt, Sara M; Seagraves, Nikki J; Fernbach, Susan D; Zapata, Gladys; Lewin, Mark; Towbin, Jeffrey A; Belmont, John W

    2011-03-01

    The left ventricular outflow tract (LVOT) defects aortic valve stenosis (AVS), coarctation of the aorta (COA), and hypoplastic left heart syndrome (HLHS) represent an embryologically related group of congenital cardiovascular malformations. They are common and cause substantial morbidity and mortality. Prior evidence suggests a strong genetic component in their causation. We selected NRG1, ERBB3, and ERBB4 of the epidermal growth factor receptor (EGFR) signaling pathway as candidate genes for investigation of association with LVOT defects based on the importance of this pathway in cardiac development and the phenotypes in knockout mouse models. Single nucleotide polymorphism (SNP) genotyping was performed on 343 affected case-parent trios of European ancestry. We identified a specific haplotype in intron 3 of ERBB4 that was positively associated with the combined LVOT defects phenotype (p=0.0005) and in each anatomic defect AVS, COA, and HLHS separately. Mutation screening of individuals with an LVOT defect failed to identify a coding sequence or splice site change in ERBB4. RT-PCR on lymphoblastoid cells from LVOT subjects did not show altered splice variant ratios among those homozygous for the associated haplotype. These results suggest ERBB4 is associated with LVOT defects. Further replication will be required in separate cohorts to confirm the consistency of the observed association. Copyright © 2011 Wiley-Liss, Inc.

  4. Prostate Artery Embolization for Complete Urinary Outflow Obstruction Due to Benign Prostatic Hypertrophy.

    PubMed

    Yu, Simon Chun Ho; Cho, Carmen Chi Min; Hung, Esther Hiu Yee; Chiu, Peter Ka Fung; Yee, Chi Hang; Ng, Chi Fai

    2017-01-01

    We aimed to evaluate the effectiveness of PAE in weaning of catheter and relieving obstructive urinary symptoms in patients with acute urinary retention (AUR) due to benign prostatic hypertrophy (BPH) and failed trial without catheter (TWOC). In this prospective study approved by the institutional review board, a signed informed consent was obtained. Eighteen consecutive patients with AUR due to BPH and failed TWOC were recruited. Nineteen consecutive patients with BPH but without AUR were recruited as a control. Patients with CTA evidence of arterial occlusion or significant stenosis along the prostate artery access path were excluded. PAE was performed using microspheres (100-300 μm diameter). Outcome assessment included successful weaning of catheter in 2 weeks, procedure-related complications, change of symptomatology and urodynamic findings at 1 month as compared to baseline, percent non-perfused prostate volume, and prostate volume reduction on MRI at 2 weeks. Two patients in the study group and four in the control group were excluded due to arterial pathology. Embolization of bilateral prostate arteries was achieved in all patients in both the groups (100%). There was no complication. The catheter was successfully weaned in 87.5% (14/16) of patients within 14 days in the treatment group. There was no significant difference in patient demographics, prostate characteristics, and all outcome assessment parameters between both the groups. PAE was probably safe and effective in weaning of catheter and relieving obstructive urinary symptoms in patients due to BPH, with treatment outcomes comparable to those without AUR.

  5. AB298. SPR-25 NLRP3/IL-1β mediates denervation during bladder outlet obstruction in rats

    PubMed Central

    Lutolf, Robin; Hughes, Francis M.; Purves, J. Todd

    2016-01-01

    Objective Bladder outlet obstruction (BOO) is a common condition resulting from benign prostatic hyperplasia, neurologic pathology, organ prolapse, etc. Long-term, obstruction is well-established to evoke denervation in the bladder which causes the detrusor to become hypocontractile, resulting in inefficient bladder emptying and consequent infections, continence issues or even renal failure. Recently, considerable attention has been paid to a role for inflammation in bladder deterioration during BOO and we have shown a central role for the NLRP3 inflammasome in triggering this inflammation. In the present study we explore a possible connection between this NLRP3-induced inflammation and bladder denervation. Methods Rats were divided into five groups: (I) control; (II) sham operated; (III) BOO + vehicle (1 mL, 40% ethanol in PBS, p.o.); (IV) BOO + glyburide (Gly, NLRP3 inhibitor; 10 mg/kg, p.o.); (V) BOO + anakinra (Ana, IL-1 receptor antagonist; 25 mg/kg, i.p.). BOO is constructed in female rats by inserting a 1 mm outer diameter transurethral catheter, tying a silk ligature around the urethra and removing the catheter. Medications were administered prior to surgery and once daily. At 12 days animals were sacrificed and the bladders processed for histological analysis. Transverse sections (5 µm) were stained for PGP9.5 expression (a pan-neuronal marker) using standard immunohistochemistry techniques. Entire sections were scanned, using a 10× objective, into TIFF files using Zen software (Zeiss Inc.). Images were imported into Elements software (Nikon Inc.) and the area of individual neurons designated as well as total bladder area (exclusive of the urothelium and lumen). The number of neurons and respective areas were used to calculate nerve density. Results Denervation in the bladder wall during BOO was significant, as measured by nerve density. This effect was attenuated by either preventing NLRP3 activation with Gly or blocking IL-1β’s action at its

  6. Inheritance analysis of congenital left ventricular outflow tract obstruction malformations: Segregation, multiplex relative risk, and heritability.

    PubMed

    McBride, Kim L; Pignatelli, Ricardo; Lewin, Mark; Ho, Trang; Fernbach, Susan; Menesses, Andres; Lam, Wilbur; Leal, Suzanne M; Kaplan, Norman; Schliekelman, Paul; Towbin, Jeffrey A; Belmont, John W

    2005-04-15

    The left ventricular outflow tract (LVOTO) malformations, aortic valve stenosis (AVS), coarctation of the aorta (COA), and hypoplastic left heart (HLH) constitute a mechanistically defined subgroup of congenital heart defects that have substantial evidence for a genetic component. Evidence from echocardiography studies has shown that bicuspid aortic valve (BAV) is found frequently in relatives of children with LVOTO defects. However, formal inheritance analysis has not been performed. We ascertained 124 families by an index case with AVS, COA, or HLH. A total of 413 relatives were enrolled in the study, of which 351 had detailed echocardiography exams for structural heart defects and measurements of a variety of aortic arch, left ventricle, and valve structures. LVOTO malformations were noted in 30 relatives (18 BAV, 5 HLH, 3 COA, and 3 AVS), along with significant congenital heart defects (CHD) in 2 others (32/413; 7.7%). Relative risk for first-degree relatives in this group was 36.9, with a heritability of 0.71-0.90. Formal segregation analysis suggests that one or more minor loci with rare dominant alleles may be operative in a subset of families. Multiplex relative risk analysis, which estimates number of loci, had the highest maximum likelihood score in a model with 2 loci (range of 1-6 in the lod-1 support interval). Heritability of several aortic arch measurements and aortic valve was significant. These data support a complex but most likely oligogenic pattern of inheritance. A combination of linkage and association study designs is likely to enable LVOTO risk gene identification. This data can also provide families with important information for screening asymptomatic relatives for potentially harmful cardiac defects.

  7. Inheritance Analysis of Congenital Left Ventricular Outflow Tract Obstruction Malformations: Segregation, Multiplex Relative Risk, and Heritability

    PubMed Central

    McBride, Kim L.; Pignatelli, Ricardo; Lewin, Mark; Ho, Trang; Fernbach, Susan; Menesses, Andres; Lam, Wilbur; Leal, Suzanne M.; Kaplan, Norman; Schliekelman, Paul; Towbin, Jeffrey A.; Belmont, John W.

    2006-01-01

    The left ventricular outflow tract (LVOTO) malformations, aortic valve stenosis (AVS), coarctation of the aorta (COA), and hypoplastic left heart (HLH) constitute a mechanistically defined subgroup of congenital heart defects that have substantial evidence for a genetic component. Evidence from echocardiography studies has shown that bicuspid aortic valve (BAV) is found frequently in relatives of children with LVOTO defects. However, formal inheritance analysis has not been performed. We ascertained 124 families by an index case with AVS, COA, or HLH. A total of 413 relatives were enrolled in the study, of which 351 had detailed echocardiography exams for structural heart defects and measurements of a variety of aortic arch, left ventricle, and valve structures. LVOTO malformations were noted in 30 relatives (18 BAV, 5 HLH, 3 COA, and 3 AVS), along with significant congenital heart defects (CHD) in 2 others (32/413; 7.7%). Relative risk for first-degree relatives in this group was 36.9, with a heritability of 0.71–0.90. Formal segregation analysis suggests that one or more minor loci with rare dominant alleles may be operative in a subset of families. Multiplex relative risk analysis, which estimates number of loci, had the highest maximum likelihood score in a model with 2 loci (range of 1–6 in the lod-1 support interval). Heritability of several aortic arch measurements and aortic valve was significant. These data support a complex but most likely oligogenic pattern of inheritance. A combination of linkage and association study designs is likely to enable LVOTO risk gene identification. This data can also provide families with important information for screening asymptomatic relatives for potentially harmful cardiac defects. PMID:15690347

  8. Increased penile expression of transforming growth factor and elevated systemic oxidative stress in rabbits with chronic partial bladder outlet obstruction.

    PubMed

    Lin, W-Y; Chang, P-J; Lin, Y-P; Wu, S-B; Chen, C-S; Levin, R M; Wei, Y-H

    2012-02-01

    There is a growing body of evidence to support the direct link between obstructive bladder dysfunction and erectile dysfunction (ED). However, there have been few pathophysiological studies to determine the relationship between lower urinary tract syndrome (LUTS) and ED. As the transforming growth factor-β1 (TGF-β1) that induces the synthesis of collagen in the penile tissues is critical for the development of ED, the first aim of this study was to investigate the expression of TGF-β1 in the penis from male rabbits with chronic partial bladder outlet obstruction (PBOO). Besides, it has been suggested that oxidative stress plays a significant role in the pathophysiological mechanism of ED. Thus, the second aim of this study was to further investigate whether the urinary or serum oxidative stress markers are involved in chronic PBOO-induced penile dysfunction. A total of 16 male New Zealand White rabbits were separated equally into four groups: a control group and PBOO groups obstructed for 2, 4 and 8 weeks respectively. Using the RT-PCR and Western blot analysis, a progressive increase of TGF-β1 in penis was found at 2, 4 and 8 weeks after obstruction. Moreover, the biomarkers for oxidative stress or oxidative damage were significantly detected in the penis of rabbits after PBOO, which include the enhancement of 8-hydroxy-2'-deoxyguanosine (8-OHdG) in urine and plasma, plasma malondialdehyde (MDA) and total antioxidant capacity (TAC), as well as reduction of glutathione (GSH). On the basis of our results, the increase of TGF-β1 and elevated systemic oxidative stress may play key roles to contribute to penile dysfunction after chronic PBOO. © 2011 The Authors. International Journal of Andrology © 2011 European Academy of Andrology.

  9. Flat carcinoma in Situ of bladder.

    PubMed

    Riddle, P R; Chisholm, G D; Trott, P A; Pugh, R C

    1975-01-01

    36 patients with flat carcinoma in situ of the bladder have been reviewed. Those with widespread disease usually presented with dysuria or obstructive outflow tract symptoms and radical surgery appeared to give better results than radiotherapy. However, when the lesion was confined to small areas of the bladder mucosa, haematuria or pain were the main presenting symptoms and a conservative approach seemed justified. It is suggested that the term flat carcinoma in situ be used for this lesion whose behavior differs significantly from that of the commoner papillary or invasive tumours. The pathological appearances are to be reported elsewhere in full.

  10. The use of biodegradable PGA stents to judge the risk of post-TURP incontinence in patients with combined bladder outlet obstruction and overactive bladder.

    PubMed

    Knutson, Tomas; Pettersson, Silas; Dahlstrand, Christer

    2002-09-01

    For patients with the combination of severe bladder outlet obstruction (BOO) and severe overactive bladder (OB), no straightforward and safe treatment exists due to the risk of urge incontinence after TURP. In this study we have used a biodegradable polyglycolic stent to simulate the status after TURP and register the risk for urge incontinence. A total of 37 patients with severe OB, combined with moderate to severe BOO, were asked if they wanted to participate. Under cystoscopic vision a polyglycolic biodegradable stent was inserted in the prostatic urethra. Twenty-five of the patients noticed no or only minor leakage and 19 of these have been subjected to TURP with good results. Three patients are on the waiting-list for TURP. Twelve of 37 patients were found to have major leakage after stent insertion. During the stent period, we noted five cases of complications, due to UTI, stent crash and irritation. All of these patients recovered within three weeks. A biodegradable PGA stent seems to be a new and unique tool to test the risk for post-TURP incontinence in patients with combined BOO and severe OB.

  11. Is benign prostatic obstruction surgery indicated for improving overactive bladder symptoms in men with lower urinary tract symptoms?

    PubMed

    Cornu, Jean-Nicolas; Grise, Philippe

    2016-01-01

    Lower urinary tract symptoms (LUTS) in men are highly prevalent, and include both storage and voiding symptoms in many cases. The effect of benign prostatic obstruction (BPO) relief on storage symptoms remains unclear. The present review summarizes data about the relation between overactive bladder (OAB), voiding symptoms, and urodynamic characteristics in men with LUTS. Pathomechanisms of OAB in a context of BPO are reviewed. Rates of persistent bladder dysfunction after BPO relief are described along with predictive factors of persisting OAB. OAB is a common clinical feature in a population of male LUTS, often concomitant with voiding symptoms. Although detrusor overactivity is found in some patients with OAB and BPO, there is no absolute correspondence between clinical symptoms and urodynamic findings. In the context of BPO, OAB pathophysiology implicates nitric oxide pathway, bladder ischemia, ageing of the urinary tract, and calcium-activated potassium channels activity. BPO relief can be followed in the medium term by persistence of OAB symptoms, and preoperative detrusor overactivity has been identified as the main predictive factor. However, preoperative urodynamics remain only indicated in specific cases, when it could directly influence clinical decision-making. Antimuscarinics may be the treatment of choice for persistent symptoms after surgery, but there is no firm recommendation in this clinical setting.

  12. Dissimilar Effects of Tolterodine on Detrusor Overactivity in Awake Rats with Chemical Cystitis and Partial Bladder Outlet Obstruction

    PubMed Central

    Jin, Long-Hu; Park, Chang-Shin; Shin, Hwa-Yeon; Yoon, Sang-Min

    2011-01-01

    Purpose We investigated bladder function, with a special focus on nonvoiding contractions (NVCs), in awake rats with chronic chemical cystitis and bladder outlet obstruction (BOO) by use of simultaneous registrations of intravesical and intraabdominal pressures. In addition, we tested the effects of tolterodine on the NVCs in these models. Methods A total of 20 female Sprague-Dawley rats were used in this study. In eight rats, chemical cystitis was induced by intravesical instillation of HCl. Twelve rats were subjected to sham instillations or partial BOO. Four weeks after intravesical instillation or 2 weeks after partial BOO, cystometrograms were obtained by use of simultaneous recording of intravesical and intraabdominal pressure in all unanesthetized, unrestrained rats in metabolic cages. Results A total of 17 rats survived. In the rats with acute injury by HCl, 50% showed detrusor overactivity (DO), which was not seen in the sham group. The cystitis group had lower DO pressure without a difference in DO frequency compared with the BOO group. After the administration of tolterodine, the cystitis group showed no difference in DO frequency or pressure, whereas the BOO group showed decreased values for both parameters. Conclusions Our study showed that toleterodine produced no effect on DO during the filling phase in rats with chronic chemical cystitisbut decreased the frequency and pressure of DO in rats with BOO. Clinically, studies are needed to improve the treatment effect of anticholinergic drugs ininterstitial cystitis patients with overactive bladder. PMID:22087420

  13. MiR-133 modulates TGF-β1-induced bladder smooth muscle cell hypertrophic and fibrotic response: implication for a role of microRNA in bladder wall remodeling caused by bladder outlet obstruction.

    PubMed

    Duan, Liu Jian; Qi, Jun; Kong, Xiang Jie; Huang, Tao; Qian, Xiao Qiang; Xu, Ding; Liang, Jun Hao; Kang, Jian

    2015-02-01

    Bladder outlet obstruction (BOO) evokes urinary bladder wall remodeling significantly, including the phenotype shift of bladder smooth muscle cells (BSMCs) where transforming growth factor-beta1 (TGF-β1) plays a pivotal role given the emerging function of modulating cellular phenotype. miR-133 plays a role in cardiac and muscle remodeling, however, little is known about its roles in TGF-β1-induced BSMC hypertrophic and fibrotic response. Here, we verified BOO induced bladder wall remodeling and TGF-β1 expression mainly located in bladder endothelium. Furthermore, we uncovered miR-133a/b expression profile in BOO rats, and then explored its regulated effects on BSMCs' phenotypic shift. Our study found that miR-133 became down-regulated during rat bladder remodeling. Next, we sought to examine whether the expression of miR-133 was down-regulated in primary BSMCs in response to TGF-β1 stimulation and whether forced overexpression of miR-133 could regulate profibrotic TGF-β signaling. We found that stimulation of BSMCs with exogenous TGF-β1 of increasing concentrations resulted in a dose-dependent decrease of miR-133a/b levels and transfection with miR-133 mimics attenuated TGF-β1-induced α-smooth muscle actin, extracellular matrix subtypes and fibrotic growth factor expression, whereas it upregulated high molecular weight caldesmon expression compared with the negative control. Also, downregulation of p-Smad3, not p-Smad2 by miR-133 was detected. Additionally, miR-133 overexpression suppressed TGF-β1-induced BSMC hypertrophy and proliferation through influencing cell cycle distribution. Bioinformatics analyses predicted that connective tissue growth factor (CTGF) was the potential target of miR-133, and then binding to the 3'-untranslated region of CTGF was validated by luciferase reporter assay. These results reveal a novel regulator for miR-133 to modulate TGF-β1-induced BSMC phenotypic changes by targeting CTGF through the TGF-β-Smad3 signaling pathway

  14. 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

  15. Testosterone and 17β-estradiol induce glandular prostatic growth, bladder outlet obstruction, and voiding dysfunction in male mice.

    PubMed

    Nicholson, Tristan M; Ricke, Emily A; Marker, Paul C; Miano, Joseph M; Mayer, Robert D; Timms, Barry G; vom Saal, Frederick S; Wood, Ronald W; Ricke, William A

    2012-11-01

    Benign prostatic hyperplasia (BPH) and bladder outlet obstruction (BOO) are common in older men and can contribute to lower urinary tract symptoms that significantly impact quality of life. Few existing models of BOO and BPH use physiological levels of hormones associated with disease progression in humans in a genetically manipulable organism. We present a model of BPH and BOO induced in mice with testosterone (T) and 17β-estradiol (E(2)). Male mice were surgically implanted with slow-releasing sc pellets containing 25 mg T and 2.5 mg E(2) (T+E(2)). After 2 and 4 months of hormone treatment, we evaluated voiding patterns and examined the gross morphology and histology of the bladder, urethra, and prostate. Mice treated with T+E(2) developed significantly larger bladders than untreated mice, consistent with BOO. Some mice treated with T+E(2) had complications in the form of bladder hypertrophy, diverticula, calculi, and eventual decompensation with hydronephrosis. Hormone treatment caused a significant decrease in the size of the urethral lumen, increased prostate mass, and increased number of prostatic ducts associated with the prostatic urethra, compared with untreated mice. Voiding dysfunction was observed in mice treated with T+E(2), who exhibited droplet voiding pattern with significantly decreased void mass, shorter void duration, and fewer sustained voids. The constellation of lower urinary tract abnormalities, including BOO, enlarged prostates, and voiding dysfunction seen in male mice treated with T+E(2) is consistent with BPH in men. This model is suitable for better understanding molecular mechanisms and for developing novel strategies to address BPH and BOO.

  16. Testosterone and 17β-Estradiol Induce Glandular Prostatic Growth, Bladder Outlet Obstruction, and Voiding Dysfunction in Male Mice

    PubMed Central

    Nicholson, Tristan M.; Ricke, Emily A.; Marker, Paul C.; Miano, Joseph M.; Mayer, Robert D.; Timms, Barry G.; vom Saal, Frederick S.; Wood, Ronald W.

    2012-01-01

    Benign prostatic hyperplasia (BPH) and bladder outlet obstruction (BOO) are common in older men and can contribute to lower urinary tract symptoms that significantly impact quality of life. Few existing models of BOO and BPH use physiological levels of hormones associated with disease progression in humans in a genetically manipulable organism. We present a model of BPH and BOO induced in mice with testosterone (T) and 17β-estradiol (E2). Male mice were surgically implanted with slow-releasing sc pellets containing 25 mg T and 2.5 mg E2 (T+E2). After 2 and 4 months of hormone treatment, we evaluated voiding patterns and examined the gross morphology and histology of the bladder, urethra, and prostate. Mice treated with T+E2 developed significantly larger bladders than untreated mice, consistent with BOO. Some mice treated with T+E2 had complications in the form of bladder hypertrophy, diverticula, calculi, and eventual decompensation with hydronephrosis. Hormone treatment caused a significant decrease in the size of the urethral lumen, increased prostate mass, and increased number of prostatic ducts associated with the prostatic urethra, compared with untreated mice. Voiding dysfunction was observed in mice treated with T+E2, who exhibited droplet voiding pattern with significantly decreased void mass, shorter void duration, and fewer sustained voids. The constellation of lower urinary tract abnormalities, including BOO, enlarged prostates, and voiding dysfunction seen in male mice treated with T+E2 is consistent with BPH in men. This model is suitable for better understanding molecular mechanisms and for developing novel strategies to address BPH and BOO. PMID:22948219

  17. Risk Factors for Hepatic Venous Outflow Obstruction in Piggyback Liver Transplantation: The Role of Recipient's Pattern of Hepatic Veins Drainage into the Inferior Vena Cava.

    PubMed

    Ye, Qifa; Zeng, Cheng; Wang, Yanfeng; Fang, Zhehong; Hu, Xiaoyan; Xiong, Yan; Li, Ling

    2017-05-19

    BACKGROUND The recipient's pattern of hepatic veins (HVs) drainage into the inferior vena cava (IVC) (drainage pattern, for short) may influence outflow reconstruction and thus hepatic venous outflow obstruction (HVOO) in piggyback liver transplantation (PBLT). However, no previous study has investigated this association. MATERIAL AND METHODS A retrospective analysis of 202 PBLT (2000-2016) was conducted. Based on drainage patterns, the patients were divided into Group A (common trunk of left and middle HVs), Group B (common trunk of right and middle HVs), and Group C (common trunk of 3 HVs). Patients' demographic and surgical data were compared within the 3 groups, and risk factors for HVOO were tested using a multiple logistic regression model. RESULTS A chi-square test revealed a significantly higher HVOO incidence in Group 1 compared with the other groups (23.5% vs. 9.6% vs. 7.1%, p=0.047). The demographics and surgical data except angleÐAOB between the reconstructed outflow and IVC in cross-section of 3D image (∠AOB), ratio of the length of reconstructed outflow and ∠AOB (LRO/∠AOB ratio), and types of HV ligation did not differ significantly within the 3 groups. ∠AOB and LRO/∠AOB ratio were used to assess the level of anastomosis twisting and compression, respectively. Among the 3 groups, the largest ∠AOB and highest LRO/∠AOB ratio were observed in Group A and B, respectively. In addition, multivariate analysis indicated that the ÐAOB (OR=1.016, 95%CI: 1.006-1.027) and LRO/ÐAOB ratio (OR=2.254, 95% CI: 1.041-5.519) were risk factors for HVOO. CONCLUSIONS This study demonstrated that drainage patterns were associated with HVOO. The best choice for outflow reconstruction is Group C. The patients in Group A and B were likely to develop HVOO due to anastomosis twisting and compression, respectively.

  18. Robotic-assisted urethrolysis for urethral obstruction after retropubic bladder neck suspension-a case series report.

    PubMed

    Orasanu, Bogdan; Marotte, Jeffrey; Pasko, Bryce; Hijaz, Adonis; Daneshgari, Firouz

    2014-02-01

    Urethral/bladder outlet obstruction (BOO) is a recognized complication after most surgical procedures for stress urinary incontinence. The mechanisms involved are thought to be related to an overcorrection of the urethra (by kinking and/or compressing the urethra) or excessive scar formation between the pubis and urethra. The recommended treatment is usually surgical that aims to free up the obstructed urethra (urethrolysis). For retropubic bladder neck suspension (BNS), robotic-assisted surgery offers a less invasive alternative to classical abdominal approach. We report methods and results of performing robotic-assisted urethrolysis in patients with urethral obstruction after Burch colposuspension. Six patients presented with voiding difficulties and urinary irritative symptoms after an abdominal hysterectomy and Burch colposuspension. BOO was diagnosed based on history, presenting symptoms, and urodynamic findings, including the maximum flow rate (Qmax) of ≤12 mL/second and detrusor pressure at maximum flow (PdetQmax) of ≥20 cmH2O. Patients underwent robotic-assisted urethrolysis, which consisted of the usual robotic exposure of the abdominal cavity, access to the space of Retzius, removal of Burch sutures, and hypermobilization of the urethra. The intraoperative and postoperative complications, recovery time, and outcome of the procedure to successfully address the patients' symptoms were reviewed and herein reported. Postoperatively, five of the six patients had complete resolution of the obstructive and irritative symptoms. All had improvement of the postvoid residual volume with a median of 46.5 mL (range 0-176 mL). Postoperatively, urodynamic studies were repeated in two patients and PdetQmax decreased from 39 cmH2O before surgery to 21 cmH2O after urethrolysis and from 31 to 21 cmH2O, respectively. Qmax increased from 0 to 17 mL/second and from 6 to 10 mL/second, respectively. Robotic-assisted urethrolysis is a feasible and attractive

  19. 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

  20. 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

  1. Computed tomography imaging to quantify the area of the endocardial subvalvular apparatus in hypertrophic cardiomyopathy - Relationship to outflow tract obstruction and symptoms.

    PubMed

    Tajima, Miyu; Iguchi, Nobuo; Utanohara, Yuko; Hiroi, Yukio; Mahara, Keitaro; Niwa, Tatsunori; Takayama, Morimasa; Sumiyoshi, Tetsuya; Tomoike, Hitonobu

    2016-01-01

    Abnormalities of the endocardial subvalvular apparatus (SVA), which includes the papillary muscles directly attached to the mitral leaflet and left ventricular apical-basal muscle bundles, are occasionally identified in hypertrophic cardiomyopathy (HCM). Their associations with left ventricular outflow tract (LVOT) obstruction are unknown. We retrospectively reviewed cardiac computed tomography image data sets of 107 consecutive patients with HCM [56 obstructive (HOCM) and 51 non-obstructive (HNOCM)] as well as 53 controls. We evaluated anomalies of the SVA, measured the cross-sectional area of the SVA at the level of the LVOT, and subsequently assessed its correlation with the LVOT pressure gradient with and without medication. The area of the SVA was greater in HOCM than in HNOCM patients and in the control group (2.5 ± 1.3 cm(2), 1.4 ± 0.8 cm(2), and 0.9 ± 0.6 cm(2), respectively; p < 0.0001). Anomalies in the SVA were more often observed in the HOCM group than in the HNOCM patients and controls (abnormal papillary muscles, 14%, 8%, and 0%, respectively; P = 0.010; LV apical-basal muscle bundles, 73%, 65%, and 45%, respectively; P = 0.0094). Among HOCM patients, logistic regression analysis demonstrated that an SVA area of 2.2 cm(2) was an independent risk factor of residual severe LVOT obstruction (≥50 mmHg) after medication (odds ratio, 10.1; 95% confidence interval, 2.05-49.80). An increased area of the endocardial subvalvular apparatus could be an independent risk factor for clinically relevant LVOT obstruction refractory to medication. Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  2. Stereological comparison of the effects of pentoxifylline, captopril, simvastatin, and tamoxifen on kidney and bladder structure after partial urethral obstruction in rats.

    PubMed

    Shirazi, Mehdi; Soltani, Mohammad-Reza; Jahanabadi, Zahra; Abdollahifar, Mohammad-Amin; Tanideh, Nader; Noorafshan, Ali

    2014-11-01

    Limited studies have shown antifibrotic effects of pentoxifylline, captopril, simvastatin, and tamoxifen. No comparisons are available of the effects of these drugs on prevention of renal and bladder changes in partial urethral obstruction (PUO). The rats were divided into six groups (n=7). The sham-operated rats (group I) only underwent laparotomy and did not receive any treatments. The PUO groups (group II-VI) received normal saline (PUO+NS), pentoxifylline (100 mg/kg/d; PUO+PEN), captopril (35 mg/kg/d; PUO+CAP), simvastatin (15 mg/kg/d; PUO+SIM), or tamoxifen (10 mg/kg/d; PUO+TAM) by gavage for 28 days. Then, the volume and/or length of the kidney components (tubules, vessels, and fibrous tissue) and the bladder components (epithelial and muscular layers, fibrous tissue, fibroblast and fibrocyte number) were quantitatively evaluated on the microscopic sections by use of stereological techniques. The volume of renal and bladder fibrosis was significantly ameliorated in the PUO+PEN group, followed by the PUO+CAP, PUO+SIM, and PUO+TAM groups. Also, the volume and length of the renal tubules and vessels and bladder layers were more significantly protected in the PUO+PEN group, followed by the PUO+CAP, PUO+SIM, and PUO+TAM groups. Treatment of PUO with PEN was more effective in the prevention of renal and bladder fibrosis and in the preservation of renal and bladder structures.

  3. Enterolith causing bladder outlet obstruction in patient with imperforate anus. A rare case presentation.

    PubMed

    Hussain, Mudassir; Muhammad, Shah; Khan, Muhammad Arsalan; Manzoor, Muhammad

    2015-12-01

    Imperforate anus is a rare anomaly associated with defects commonly referred to as vertebral defects, anal atresia, cardiac defects, tracheo-oesophageal fistula, renal anomalies and limb abnormalities (VACTERL). With modern surgical procedures the overall outcome is excellent. Permanent colostomy which is required in some cases of this disease can result in some rare complications such as enteroliths formation, as illustrated in the case we are presenting here related to a 28-year-old male who reported at urology emergency with features of urinary and acute large bowel obstruction. On investigation he was found to have two enteroliths in his distal loop of sigmoid colostomy. The more distal of the two enteroliths caused urinary retention and hence acute renal failure, and the proximal one caused large bowel obstruction by compressing the proximal loop of colostomy. This case demonstrates that the blind distal sigmoid colostomy loop can grow enteroliths secondary to stasis of its own contents over a long period.

  4. Evaluation of the effects of omega-3 & interferon alpha-2b administration on partial bladder outlet obstruction in a rat model

    PubMed Central

    Firat, Fatih; Uluocak, Nihat; Erdemir, Fikret; Atilgan, Dogan; Markoc, Fatma; Parlaktas, Bekir Suha; Yasar, Adem

    2016-01-01

    Background & objectives: In bladder outlet obstruction-induced rat models, the transforming growth factor-beta (TGF-β) and collagen ratios have been shown to be increased. Increased TGF-β leads to fibrosis. In this study, the effect of omega-3 and interferon alpha-2b (IFN α-2b) was investigated on oxidative stress, inflammation and fibrosis in bladder structure in a partial bladder outlet obstruction (PBOO) rat model. Methods: A total of 35 male Wistar albino rats, weighing 300-350 g, were used in the study. The rats were randomly divided into five groups. At the end of the experimental period, bladders were harvested from all the rats, and pathological analysis of the rat bladder tissues was performed. In addition, investigations were carried out with enzymatic and non-enzymatic antioxidant systems to study the antioxidant properties of omega-3 fatty acid and IFN alpha-2b. Results: Increased bladder weight in the PBOO group, in comparison to the control group, was decreased by the administration of omega-3 and IFN α-2b (P=0.002). Significantly higher superoxide dismutase (SOD) levels were detected in group 2 in comparison to the control group. It was also detected that serum SOD, glutathione peroxidase and nitric oxide (NO) levels were significantly higher in group 2 when compared to the control group (P<0.05). In the pathologic evaluation, group 2 showed significantly increased inflammation and fibrosis compared to the control group. Omega-3 treatment significantly decreased inflammation. It was shown that IFN α-2b application partially decreased inflammation. Interpretation & conclusions: The results of the present study showed that in addition to the standard primary approaches to prevent the damage to the upper urinary tract secondary to PBOO, omega-3 fatty acid and IFN α-2b could be beneficial as adjunct treatment in clinical practice. However, this needs to be further investigated with prospective, randomized clinical trials with larger sample sizes

  5. Intentional Laceration of the Anterior Mitral Valve Leaflet to Prevent Left Ventricular Outflow Tract Obstruction During Transcatheter Mitral Valve Replacement: Pre-Clinical Findings.

    PubMed

    Khan, Jaffar M; Rogers, Toby; Schenke, William H; Mazal, Jonathan R; Faranesh, Anthony Z; Greenbaum, Adam B; Babaliaros, Vasilis C; Chen, Marcus Y; Lederman, Robert J

    2016-09-12

    The authors propose a novel transcatheter transection of the anterior mitral leaflet to prevent iatrogenic left ventricular outflow tract (LVOT) obstruction during transcatheter mitral valve replacement (TMVR). LVOT obstruction is a life-threatening complication of TMVR caused by septal displacement of the anterior mitral leaflet. In vivo procedures in swine were guided by biplane x-ray fluoroscopy and intracardiac echocardiography. Retrograde transaortic 6-F guiding catheters straddled the anterior mitral leaflet. A stiff 0.014-inch guidewire with polymer jacket insulation was electrified and advanced from the LVOT, through the A2 leaflet base, into the left atrium. The wire was snared and externalized, forming a loop that was energized and withdrawn to lacerate the anterior mitral leaflet. The anterior mitral leaflet was successfully lacerated in 7 live and 1 post-mortem swine under heparinization. Lacerations extended to 89 ± 19% of leaflet length and were located within 0.5 ± 0.4 mm of leaflet centerline. The chordae were preserved and retracted the leaflet halves away from the LVOT. LVOT narrowing after benchtop TMVR was significantly reduced with intentional laceration of the anterior mitral leaflet to prevent LVOT obstruction than without (65 ± 10% vs. 31 ± 18% of pre-implantation diameter, p < 0.01). The technique caused mean blood pressure to fall (from 54 ± 6 mm Hg to 30 ± 4 mm Hg, p < 0.01), but blood pressure remained steady until planned euthanasia. No collateral tissue injury was identified on necropsy. Using simple catheter techniques, the anterior mitral valve leaflet was transected. Cautiously applied in patients, this strategy can prevent anterior mitral leaflet displacement and LVOT obstruction caused by TMVR. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  6. Total Clinical Course and Autopsy Findings of Left Ventricular Outflow Tract Obstruction Due to Sigmoid Septum: Histologically Proven Isolated Basal Septal Hypertrophy.

    PubMed

    Kawai, Keisuke; Sengoku, Hiroyuki; Ishihara, Hiroyuki; Akematsu, Tomotoshi; Nanahoshi, Masakazu; Hariki, Hirotoshi; Hasokawa, Minoru; Hirata, Ken-Ichi; Yamabe, Hiroshi

    2017-08-15

    We herein report the total course and autopsy findings of a woman who complained of chest discomfort and had plasma B-type natriuretic peptide 43 pg/mL and left ventricular outflow tract obstruction (with a resting pressure gradient of 181 mmHg) due to sigmoid septum at 73 years of age. Betaxolol and verapamil decreased her pressure gradient to 14 mmHg, but the pressure gradient (101 mmHg) again worsened. The betaxolol dose was increased and cibenzoline was added, resulting in a pressure gradient ≤21 mmHg. An autopsy was performed after death from a urinary tract infection at 80 years of age. The absence of any disarray of cardiac myocytes was confirmed.

  7. The midterm and long-term results of the Mustard operation in patients with transposition of the great vessels and dynamic left ventricular outflow tract obstruction.

    PubMed

    Stewart, S; Harris, P J; Manning, J

    1986-03-01

    Eight of 43 patients with transposition of the great vessels (TGV) and either an intact ventricular septum or very small ventricular septal defect were found to have dynamic left ventricular outflow tract obstruction (LVOTO). The preoperative left ventricle-pulmonary artery (LV-PA) pressure gradient ranged between 14 and 60 mm Hg. In 3 patients the pulmonary artery could not be catheterized. They had a left ventricular pressure of 43, 45, and 62 mm Hg, respectively, no evidence of pulmonary vascular disease, and either echocardiographic or angiocardiographic demonstration of LVOTO. The outflow tract was explored in 3 patients at the time of the Mustard operation. Exposure of the LVOT was difficult, particularly in patients less than 6 months of age. A shallow septal myectomy was performed in 1 patient; a thin fibrous endocardial scar was resected in 2; and no procedure was performed in the third. All 8 patients survived and remain asymptomatic 1 to 11 years (mean, 5 years) after operation. The LV-PA pressure gradient has either remained the same or has increased in every patient except 1 in whom there was a slight reduction in the gradient. We conclude that dynamic LVOTO persists after the Mustard operation and is not amenable to direct surgical relief. However, an excellent clinical result can be obtained for up to 11 years after operation.

  8. Dependence of ultrasound decorrelation on urine scatter particle concentration for a non-invasive diagnosis of bladder outlet obstruction.

    PubMed

    Arif, Muhammad; Idzenga, Tim; de Korte, Chris L; van Mastrigt, Ron

    2015-11-01

    To develop a non-invasive method to diagnose Bladder Outlet Obstruction (BOO) based on decorrelation of subsequently acquired UltraSound (US) data of urinary flow, we studied the influence of scatter particle concentration on the decorrelation process in urethra models using both aqueous solutions of scattering particles and urine samples. A tissue mimicking urethra model made from PolyVinyl Alcohol (PVA) solution was infused with seven aqueous solutions containing different particle concentrations at a constant flow rate value of 10 ml/sec. The average correlation coefficients between subsequent US images were calculated and plotted as a function of particle concentration. This procedure was also applied to stepwise diluted urine samples from nine healthy volunteers. An inversely exponential curve was fitted to the experimental data to estimate the scatter particle concentration in the urine samples. The average correlation values between subsequent US images increased with the particle concentration. The morning urine samples contained an appropriate number of scattering particles to make clinical application of the decorrelation method possible. The fitted correlation curves made an estimation of urine particle concentration possible. The results of this study show that morning urine is suitable for US decorrelation without correcting for differences in particle concentration. © 2014 Wiley Periodicals, Inc.

  9. Magnetic Resonance Imaging and Molecular Characterization of a Hormone-Mediated Murine Model of Prostate Enlargement and Bladder Outlet Obstruction.

    PubMed

    McAuley, Erin M; Mustafi, Devkumar; Simons, Brian W; Valek, Rebecca; Zamora, Marta; Markiewicz, Erica; Lamperis, Sophia; Williams, Anthony; Roman, Brian B; Vezina, Chad; Karczmar, Greg; Oto, Aytekin; Vander Griend, Donald J

    2017-08-17

    Urinary complications resulting from benign prostatic hyperplasia (BPH) and bladder outlet obstruction (BOO) continue to be a serious health problem. Novel animal model systems and imaging approaches are needed to understand the mechanisms of disease initiation, and to develop novel therapies for BPH. Long-term administration of both estradiol (E) and testosterone (T) in mice can result in prostatic enlargement and recapitulate several clinical components of lower urinary tract symptoms (LUTS). Here we use longitudinal magnetic resonance imaging (MRI) and histological analyses to quantify changes in prostatic volume, urethral volume, and genitourinary vascularization over time in response to estradiol-induced prostatic enlargement. Our data demonstrate significant prostatic enlargement by 12 weeks post-treatment, with no detectable immune infiltrate by macrophages, T- or B-cell populations. Importantly, the percentage of cell death as measured by TUNEL was significantly decreased in the prostatic epithelium of treated animals as compared to controls. We found no significant change in prostate cell proliferation in treated mice when compared to controls. These studies highlight the utility of MRI to quantify changes in prostatic and urethral volumes over time. In conjunction with histological analyses, this approach has the high potential to enable mechanistic studies of initiation and progression of clinically relevant LUTS. Additionally, this model is tractable for investigation and testing of therapeutic interventions to ameliorate or potentially reverse prostatic enlargement. Copyright © 2017. Published by Elsevier Inc.

  10. Non-Invasive Clinical Parameters for the Prediction of Urodynamic Bladder Outlet Obstruction: Analysis Using Causal Bayesian Networks

    PubMed Central

    Kim, Myong; Cheeti, Abhilash; Yoo, Changwon; Choo, Minsoo; Paick, Jae-Seung; Oh, Seung-June

    2014-01-01

    Purpose To identify non-invasive clinical parameters to predict urodynamic bladder outlet obstruction (BOO) in patients with benign prostatic hyperplasia (BPH) using causal Bayesian networks (CBN). Subjects and Methods From October 2004 to August 2013, 1,381 eligible BPH patients with complete data were selected for analysis. The following clinical variables were considered: age, total prostate volume (TPV), transition zone volume (TZV), prostate specific antigen (PSA), maximum flow rate (Qmax), and post-void residual volume (PVR) on uroflowmetry, and International Prostate Symptom Score (IPSS). Among these variables, the independent predictors of BOO were selected using the CBN model. The predictive performance of the CBN model using the selected variables was verified through a logistic regression (LR) model with the same dataset. Results Mean age, TPV, and IPSS were 6.2 (±7.3, SD) years, 48.5 (±25.9) ml, and 17.9 (±7.9), respectively. The mean BOO index was 35.1 (±25.2) and 477 patients (34.5%) had urodynamic BOO (BOO index ≥40). By using the CBN model, we identified TPV, Qmax, and PVR as independent predictors of BOO. With these three variables, the BOO prediction accuracy was 73.5%. The LR model showed a similar accuracy (77.0%). However, the area under the receiver operating characteristic curve of the CBN model was statistically smaller than that of the LR model (0.772 vs. 0.798, p = 0.020). Conclusions Our study demonstrated that TPV, Qmax, and PVR are independent predictors of urodynamic BOO. PMID:25397903

  11. Palliative transurethral prostate resection for bladder outlet obstruction in patients with locally advanced prostate cancer.

    PubMed

    Crain, Donald S; Amling, Christopher L; Kane, Christopher J

    2004-02-01

    those treated with palliative TURP were more likely to have failure of the initial voiding trial (p <0.001), and require reoperation (p <0.001), chronic drainage (p = 0.001) and re-catheterization for bleeding or obstruction (p = 0.056). Palliative TURP can be performed safely in patients with advanced prostate cancer with significant improvement in urinary symptoms. However, the rates of postoperative urinary retention and reoperation are higher than in patients undergoing TURP for BPH.

  12. Bladder function in children with meningomyelocele: comparison of cine-fluoroscopy and urodynamics.

    PubMed

    Mayo, M E; Chapman, W H; Shurtleff, D B

    1979-04-01

    We have assessed 60 children on an outpatient basis with cine-fluoroscopy combined with urodynamics. Bladder and rectal pressure together with sphincter electromyography were measured during bladder filling under fluoroscopy, which was followed by measurement of rectal pressure and sphincter electromyography during voiding under fluoroscopy. Comparison of the x-ray studies and urodynamics showed that the cystogram alone was not a reliable indicator of ray studies and urodynamics showed that the cystogram along was not a reliable indicator of detrusor function. The sphincter electromyogram during voiding must be interpreted in the face of intra-abdominal pressure changes owing to straining or Credé's maneuver. Residual urine estimations and the appearance of the bladder outflow on fluoroscopy were better parameters of outflow obstruction than sphincter electromyography.

  13. Bladder outlet obstruction

    MedlinePlus

    ... AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, PA: Elsevier; 2016: ... AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, PA: Elsevier; 2016: ...

  14. Risk factors in the origin of congenital left-ventricular outflow-tract obstruction defects of the heart: a population-based case-control study.

    PubMed

    Csáky-Szunyogh, Melinda; Vereczkey, Attila; Kósa, Zsolt; Gerencsér, Balázs; Czeizel, Andrew E

    2014-01-01

    The aim of our project was to study possible etiological factors in the origin of congenital heart defects (CHDs) because in the majority of patients the underlying causes are unclear. Cases with different CHD entities as homogeneously as possible were planned for evaluation in the population-based large data set of the Hungarian Case Control Surveillance of Congenital Abnormalities. Dead or surgically corrected 302 live-born cases with different types of left-ventricular outflow tract obstructive defects (LVOT, i.e., valvular aortic stenosis 76, hypoplastic left heart syndrome 76, coarctation of the aorta 113, and other congenital anomalies of aorta 32) were compared with 469 matched controls, 38,151 controls without any defects, and 20,750 malformed controls with other isolated defects. Medically recorded pregnancy complications and chronic diseases were evaluated based on prenatal maternity logbooks, whereas acute diseases, drug treatments, and folic acid/multivitamin supplementation were analyzed both on the basis of retrospective maternal information and medical records. The results of the study showed the role of maternal diabetes in the origin of LVOT in general, while panic disorder was associated with a higher risk of hypoplastic left heart syndrome and ampicillin treatment with a higher risk of coarctation of the aorta (COA). High doses of folic acid had a protective effect regarding the manifestation of LVOT, particularly COA. In conclusion, only a minor portion of causes was shown in our study; thus, further studies are needed to understand better the underlying causal factors in the origin of LVOT.

  15. The regional myocardial microvascular dysfunction differences in hypertrophic cardiomyopathy patients with or without left ventricular outflow tract obstruction: assessment with first-pass perfusion imaging using 3.0-T cardiac magnetic resonance.

    PubMed

    Xu, Hua-yan; Yang, Zhi-gang; Sun, Jia-yu; Wen, Ling-yi; Zhang, Ge; Zhang, Shuai; Guo, Ying-kun

    2014-04-01

    To assess regional myocardial microvascular dysfunction differences in hypertrophic cardiomyopathy (HCM) patients with or without left ventricular outflow tract obstruction using 3.0-T cardiac magnetic resonance (CMR) first-pass perfusion imaging. Forty-two HCM patients, including 25 HCM patients with left ventricular outflow tract obstruction (HOCM), 17 HCM patients without left ventricular outflow tract obstruction (NOHCM), and 14 healthy subjects underwent CMR. The left ventricular (LV) function, left ventricular end-diastolic wall thickness (EDTH), and diameter of left ventricular outflow tract (LVOT) were measured and calculated. Based on the signal-time curve of the first-pass myocardium perfusion imaging, perfusion parameters including upslope, time to peak, and peak intensity, were assessed and compared by using one-way analysis of variance and independent t tests. On the first-pass perfusion imaging, lower upslope and peak intensity and longer time to peak were found in HCM patients compared with normal subjects (all p<0.05). In contrast to the NOHCM group, the average time to peak of the HOCM group was increased (13.30 ± 4.82 s vs 16.28 ± 4.90 s, p<0.05), but first-pass perfusion upslope was reduced (4.96 ± 2.55 vs 2.58 ± 0.77, p<0.05). According to the bull's-eye model, the HOCM group's average thickness of basal segments was thicker than the NOHCM group, especially the anteroseptal, inferolateral, and anterior wall values, with a corresponding lower first-pass perfusion upslope than the NOHCM group (all p<0.05). A significant correlation was observed between first-pass perfusion upslope and LV EDTH (r=-0.551, p<0.001) and LVOT diameter (r=0.472, p<0.001). The regional myocardial microvascular dysfunction differences in hypertrophic cardiomyopathy (HCM) patients with or without left ventricular outflow tract obstruction can be detected with first-pass perfusion CMR imaging. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  16. Impact of partial urethral obstruction on bladder function: time-dependent changes and functional correlates of altered expression of Ca²⁺ signaling regulators.

    PubMed

    Burmeister, David; AbouShwareb, Tamer; D'Agostino, Ralph; Andersson, Karl-Erik; Christ, George J

    2012-06-15

    In animal models of partial urethral obstruction (PUO), altered smooth muscle function/contractility may be linked to changes in molecules that regulate calcium signaling/sensitization. PUO was created in male rats, and urodynamic studies were conducted 2 and 6 wk post-PUO. Cystometric recordings were analyzed for the presence or absence of nonvoiding contractions [i.e., detrusor overactivity (DO)]. RT-PCR and Western blots were performed on a subpopulation of rats to study the relationship between the expression of RhoA, L-type Ca(2+) channels, Rho kinase-1, Rho kinase-2, inositol 1,4,5-trisphosphate, ryanodine receptor, sarco(endo)plasmic reticulum Ca(2+)-ATPase 2 and protein kinase C (PKC)-potentiated phosphatase inhibitor of 17 kDa, and urodynamic findings in the same animal. Animals displayed DO at 2 (38%) and 6 wk (43%) post-PUO, increases were seen in in vivo pressures at 2 wk, and residual volume at 6 wk. Statistical analysis of RT-PCR and Western blot data at 2 wk, during the compensatory phase of detrusor hypertrophy, documented that expression of molecules that regulate calcium signaling and sensitization was consistently lower in obstructed rats without DO than those with DO or control rats. Among rats with DO at 2 wk, linear regression analysis revealed positive correlations between in vivo pressures and protein and mRNA expression of several regulatory molecules. At 6 wk, in the presence of overt signs of bladder decompensation, no clear or consistent alterations in expression of these same targets were observed at the protein level. These data extend prior work to suggest that molecular profiling of key regulatory molecules during the progression of PUO-mediated bladder dysfunction may shed new light on potential biomarkers and/or therapeutic targets.

  17. Diagnostic value of urodynamic bladder outlet obstruction to select patients for transurethral surgery of the prostate: Systematic review and meta-analysis

    PubMed Central

    Kim, Myong; Jeong, Chang Wook; Oh, Seung-June

    2017-01-01

    Purpose To investigate the diagnostic value of urodynamic bladder outlet obstruction (BOO) in the selection of patients for transurethral surgery of the prostate. Materials and methods We systematically searched online PubMed, Embase, and Cochrane Library databases from January 1989 to June 2014. Results A total of 19 articles met the eligibility criteria for this systematic review. The eligible studies included a total of 2321 patients with a median number of 92 patients per study (range: 12–437). Of the 19 studies, 15 conducted conventional transurethral prostatectomy (TURP), and 7 used other or multiple modalities. In urodynamic bladder outlet obstruction (BOO) positive patients, the pooled mean difference (MD) was significant for better improvement of the International Prostate Symptom Score (IPSS) (pooled MD, 3.48; 95% confidence interval [CI], 1.72–5.24; p < 0.01; studies, 16; participants, 1726), quality of life score (QoL) (pooled MD, 0.56; 95% CI, 0.14–1.02; p = 0.010; studies, 9; participants, 1052), maximal flow rate (Qmax) (pooled MD, 3.86; 95% CI, 2.17–5.54; p < 0.01; studies, 17; participants, 1852), and post-void residual volume (PVR) (pooled MD, 32.46; 95% CI, 23.34–41.58; p < 0.01; studies, 10; participants, 1219) compared with that in non-BOO patients. Some comparisons showed between-study heterogeneity despite the strict selection criteria of the included studies. However, there was no clear evidence of publication bias in this meta-analysis. Conclusions Our meta-analysis results showed a significant association between urodynamic BOO and better improvements in all treatment outcome parameters. Preoperative UDS may add insight into postoperative outcomes after surgical treatment of benign prostatic hyperplasia. PMID:28241023

  18. Urodynamic Features and Significant Predictors of Bladder Outlet Obstruction in Patients With Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia and Small Prostate Volume.

    PubMed

    Kang, Minyong; Kim, Myong; Choo, Min Soo; Paick, Jae-Seung; Oh, Seung-June

    2016-03-01

    To investigate the clinical and urodynamic features of patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) according to their prostate size. We analyzed 2039 LUTS/BPH patients who underwent urodynamic study between October 2004 and August 2013. We divided the patients into three groups according to their prostate size: small (≤30 mL), moderately enlarged (31-80 mL), and large prostate (≥81 mL) groups. We compared the groups regarding age, International Prostatic Symptom Score, maximal flow rate (Qmax), postvoided residual (PVR), serum prostate-specific antigen, prostate volume measured by ultrasonography, and urodynamic findings. Patients with a small prostate had better urodynamic outcomes than those with larger prostates in overall population. Although the total prostate volume significantly correlated with the bladder outlet obstruction (BOO) index (r  =  0.51), BOO patients with a small prostate had similar Qmax, higher PVR, and lower voiding efficiency, compared to those with larger prostates. Moreover, urodynamic parameters indicating bladder abnormalities, including low compliance and involuntary detrusor contraction positivity, were similar among the groups in BOO patients. A higher proportion of detrusor underactivity was also observed in the small prostate group in BOO patients. Finally, when adjusting for potential confounding variables, we identified serum prostate-specific antigen levels (odds ratio, 1.34) and Qmax (odds ratio, 0.77) as significant predictors for BOO in LUTS/BPH patients with a small prostate. BOO patients with a small prostate showed higher PVR and poor voiding efficiency, as well as similar urodynamic bladder abnormalities, compared to those with moderately enlarged and large prostates. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. The significance and factors related to bladder outlet obstruction in pelvic floor dysfunction in preoperative urodynamic studies: A retrospective cohort study.

    PubMed

    Lee, Yoo Jin; Kim, Soo Rim; Kim, Sei Kwang; Bai, Sang Wook

    2014-01-01

    To demonstrate the significance of bladder outlet obstruction (BOO) in preoperative urodynamic studies (UDS) in women who have been diagnosed with pelvic floor dysfunction including pelvic organ prolapsed (POP) and stress urinary incontinence (SUI). The medical records of 150 patients with pelvic floor dysfunction who underwent preoperative UDS at Yonsei University Health System from 2006 to 2012 were reviewed. Under the criteria of BOO, as a maximal flow rate in free-flow study (Qmax) less than 12 mL/sec and a detrusor pressure at Qmax in pressure-flow study (PdetQmax) higher than 20 cmH2O in UDS, they were divided into two groups: a group of 50 patients with BOO and a group of 100 patients without BOO. Comparisons were made between the patients with and without BOO in preoperative UDS. In the POP-with-SUI group, 25 patients with BOO had lower mean Qmax (10.0 vs. 25.4 mL/sec, P < 0.001), higher PdetQmax (49.6 vs. 21.5 cmH2O, P < 0.001), lower maximum cystometric capacity (422.7 vs. 454.0 mL, P = 0.007), and higher postvoidal residual volume (44.3 vs. 21.1 mL, P = 0.021) than the patients without BOO. In the SUI-only group, the mean Qmax was significantly lower in the 25 patients with BOO (9.4 vs. 25.4 mL/sec, P < 0.001). The mean PdetQmax was significantly higher with BOO (39.6 vs. 25.4 cmH2O, P = 0.004). In the univariate analyses, menopause, maximum cystometric capacity, and cystoscopic bladder trabeculation were associated with BOO. In the univariate analysis, menopause, MCC and cystoscopic bladder trabeculation were associated with BOO. In the multivariate model, however, no significant association with BOO was found.

  20. Detrusor induction of miR-132/212 following bladder outlet obstruction: association with MeCP2 repression and cell viability.

    PubMed

    Sadegh, Mardjaneh Karbalaei; Ekman, Mari; Krawczyk, Katarzyna; Svensson, Daniel; Göransson, Olga; Dahan, Diana; Nilsson, Bengt-Olof; Albinsson, Sebastian; Uvelius, Bengt; Swärd, Karl

    2015-01-01

    The microRNAs (miRNAs) miR-132 and miR-212 have been found to regulate synaptic plasticity and cholinergic signaling and recent work has demonstrated roles outside of the CNS, including in smooth muscle. Here, we examined if miR-132 and miR-212 are induced in the urinary bladder following outlet obstruction and whether this correlates with effects on gene expression and cell growth. Three to seven-fold induction of miR-132/212 was found at 10 days of obstruction and this was selective for the detrusor layer. We cross-referenced putative binding sites in the miR-132/212 promoter with transcription factors that were predicted to be active in the obstruction model. This suggested involvement of Creb and Ahr in miR-132/212 induction. Creb phosphorylation (S-133) was not increased, but the number of Ahr positive nuclei increased. Moreover, we found that serum stimulation and protein kinase C activation induced miR-132/212 in human detrusor cells. To identify miR-132/212 targets, we correlated the mRNA levels of validated targets with the miRNA levels. Significant correlations between miR-132/212 and MeCP2, Ep300, Pnkd and Jarid1a were observed, and the protein levels of MeCP2, Pnkd and Ache were reduced after obstruction. Reduction of Ache however closely matched a 90% reduction of synapse density arguing that its repression was unrelated to miR-132/212 induction. Importantly, transfection of antimirs and mimics in cultured detrusor cells increased and decreased, respectively, the number of cells and led to changes in MeCP2 expression. In all, these findings show that obstruction of the urethra increases miR-132 and miR-212 in the detrusor and suggests that this influences gene expression and limits cell growth.

  1. Canadian Cardiovascular Society 2009 Consensus Conference on the management of adults with congenital heart disease: Outflow tract obstruction, coarctation of the aorta, tetralogy of Fallot, Ebstein anomaly and Marfan’s syndrome

    PubMed Central

    Silversides, Candice K; Beauchesne, Luc; Bradley, Timothy; Connelly, Michael; Niwa, Koichiro; Mulder, Barbara; Webb, Gary; Colman, Jack; Therrien, Judith

    2010-01-01

    With advances in pediatric cardiology and cardiac surgery, the population of adults with congenital heart disease (CHD) has increased. In the current era, there are more adults with CHD than children. This population has many unique issues and needs. Since the 2001 Canadian Cardiovascular Society Consensus Conference report on the management of adults with CHD, there have been significant advances in the field of adult CHD. Therefore, new clinical guidelines have been written by Canadian adult CHD physicians in collaboration with an international panel of experts in the field. Part II of the guidelines includes recommendations for the care of patients with left ventricular outflow tract obstruction and bicuspid aortic valve disease, coarctation of the aorta, right ventricular outflow tract obstruction, tetralogy of Fallot, Ebstein anomaly and Marfan’s syndrome. Topics addressed include genetics, clinical outcomes, recommended diagnostic workup, surgical and interventional options, treatment of arrhythmias, assessment of pregnancy risk and follow-up requirements. The complete document consists of four manuscripts that are published online in the present issue of The Canadian Journal of Cardiology. The complete document and references can also be found at www.ccs.ca or www.cachnet.org. PMID:20352138

  2. Five-year results from a prospective multicentre study of percutaneous pulmonary valve implantation demonstrate sustained removal of significant pulmonary regurgitation, improved right ventricular outflow tract obstruction and improved quality of life.

    PubMed

    Hager, Alfred; Schubert, Stephan; Ewert, Peter; Søndergaard, Lars; Witsenburg, Maarten; Guccione, Paolo; Benson, Lee N; Suárez de Lezo, José; Lung, Te-Hsin; Hess, John; Eicken, Andreas; Berger, Felix

    2017-02-20

    Percutaneous pulmonary valve implantation (PPVI) is used to treat patients with dysfunctional pulmonary valve conduits. Short- and longer-term results from multiple trials have outlined haemodynamic improvements. Our aim was to report the long-term results, including quality of life, from a multicentre trial in Europe and Canada. From October 2007 to April 2009, 71 patients (24 female; median age 19.0 [IQR: 14.0 to 25.0] years) were enrolled in a prospective cohort study. PPVI was performed successfully in 63 patients. At five-year follow-up four patients had died. Moderate and severe pulmonary regurgitation were completely resolved in all except one patient, who needed re-PPVI. Outflow tract obstruction improved significantly from a mean pressure gradient of 37.7±12.1 mmHg before PPVI to 17.3±9.7 mmHg at five-year follow-up; however, 11 patients needed treatment for restenosis. The EQ-5D quality of life utility index and visual analogue scale scores were both significantly improved six months post PPVI and remained so at five years. Five-year results following PPVI demonstrate resolved moderate or severe pulmonary regurgitation, improved right ventricular outflow tract obstruction, and improved quality of life.

  3. Molecular Outflows: Observed Properties

    NASA Astrophysics Data System (ADS)

    Bally, John; Lane, Adair P.

    Introduction Molecular Outflow Characteristics Recent Developments EHV CO Outflows Luminosity Dependence of Flow Properties and Statistics Optical and Near-IR Observations of Molecular Outflows Outflow Models

  4. 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.

  5. A new look at bladder neck obstruction by the food and drug administration regulators: guide lines for investigation of benign prostatic hypertrophy.

    PubMed

    Boyarsky, S; Jones, G; Paulson, D F; Prout, G R

    1976-01-01

    A basic assumption of current guide lines to test drug therapy for benign prostatic hypertrophy is that the clinical disease is caused by bladder neck obstruction and its sequelae and complications. Asymptomatic non-prostatic hypertrophy, no matter how large the adenoma, is considered to be a pre-clinical phase of the disease as long as bladder trabeculation, impairment of the flow rate and residual urine are absent. The guide lines recognize that histological changes and gross anatomical enlargement of the prostate are the essence of the disease but objective signs of current therapeutic relief of symptoms lend themselves more practically to measurement of progression or remission, whereas no current drug has a clear enough effect on prostatic histology to predict subsidence of the clinical picture. Since no one criterion or single test serves this purpose a cluster of symptoms, with flow rate and residual urine, provides the hardest data. It would be preferable for each patient to serve as his own control in a prospective double-blind randomized study, since the literature shows no uniformity of approach, methodology, patient population or other useful data for clinical norms. Guide lines have been developed with the aid of clinical pharmacologists, biostatisticians, lawyers and government officials and approved by the Food and Drug Administration. Misconceptions outside of the profession of Urology need to be dispelled and further research in methodology, urodynamics, ultrasonic evaluation of the prostate, definition of symptoms, criteria for efficacy, etiology of the disease, and mode of action of drugs, placebo and surgery were highlighted. The literature does not have an overabundance of data but does contain evidence of definite but weak drug efficacy in the treatment of this condition.

  6. Resonance metallic ureteric stent in a case of ketamine bladder induced bilateral ureteric obstruction with one year follow up.

    PubMed

    Yong, Guo Liang; Kong, Chia Yew; Ooi, Michelle Wei Xin; Lee, Eng Geap

    2015-01-01

    Upper urinary tract occlusion is well recognized in patients with chronic ketamine abuse. The mechanism is generally unknown, but the ulcerative cystitis contracture may be responsible for obstruction. We present the first reported use of the Resonance metallic ureteric stent in the management ureteric obstruction caused by ketamine-induced uropathy. A 31-year-old lady with one-year history of recreational ketamine abuse presented with symptoms related to drug-induced ulcerative cystitis over twelve-months. She presented with acute renal failure with bilateral pyonephrosis and sepsis, and was initially treated with bilateral nephrostomy insertions and antegrade stenting. The J stents recovered the renal function, but the patient suffered from recurrent urinary tract infections (UTI's) with the prosthesis in-situ. The patient successfully underwent bilateral insertion of 12cm 6.0 French Cook Resonance metallic ureteric stents. One year following the placement of the metallic stents, the patient maintained optimal renal function with no episode of UTI. Ketamine induced uropathy is a well documented complication of chronic drug-induced ulcerative cystitis. The mechanical strength and inert property of metallic ureteric stents make it an ideal device to manage this problematic benign cause of ureteric obstruction. This is the first reported case of therapeutic bilateral metallic ureteric stents in the management of patients with ketamine induced uropathy with one year follow up. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  7. Ruptured urinary bladder attributable to urethral compression by a haematoma after vertebral fracture in a bull

    PubMed Central

    2014-01-01

    Background In male cattle, rupture of the urinary bladder is usually associated with urethral obstruction by uroliths. Less common causes include urethral compression or stricture. This case report describes the findings in a young Limousion breeding bull with rupture of the urinary bladder because of urethral compression by a haematoma after coccygeal fracture. Case presentation The bull had been introduced into a 40-head Red-Holstein herd one week before being injured. One week after introduction to the herd, the bull had an acute onset of anorexia and he was referred to the clinic. There was marked abdominal distension, reduced skin turgor and enophthalmus. The serum concentration of urea and creatinine was increased. Ultrasonographic examination revealed severe ascites and abdominocentesis yielded clear yellow fluid with high urea and creatinine concentrations, which supported a diagnosis of uroperitoneum. The bull was euthanatized because of a poor prognosis. Postmortem examination revealed a comminuted fracture of the first two coccygeal vertebrae associated with a massive haematoma that obstructed entire pelvic cavity. The haematoma compressed the urethra thereby preventing outflow of urine, which resulted in a 5-cm tear ventrally at the neck of the bladder. It was assumed that the newly-introduced bull had sustained the vertebral fractures when he was mounted by a cow. Conclusions The present case study serves to expand the differential diagnosis of urinary bladder rupture. Therefore, in addition to obstructive urolithiasis, compression and stricture of the urethra might be considered in male cattle with uroperitoneum. PMID:24666697

  8. Prenatal diagnosis and risk factors for preoperative death in neonates with single right ventricle and systemic outflow obstruction: screening data from the Pediatric Heart Network Single Ventricle Reconstruction Trial(∗).

    PubMed

    Atz, Andrew M; Travison, Thomas G; Williams, Ismee A; Pearson, Gail D; Laussen, Peter C; Mahle, William T; Cook, Amanda L; Kirsh, Joel A; Sklansky, Mark; Khaikin, Svetlana; Goldberg, Caren; Frommelt, Michele; Krawczeski, Catherine; Puchalski, Michael D; Jacobs, Jeffrey P; Baffa, Jeanne M; Rychik, Jack; Ohye, Richard G

    2010-12-01

    The purpose of this analysis was to assess preoperative risk factors before the first-stage Norwood procedure in infants with hypoplastic left heart syndrome and related single-ventricle lesions and to evaluate practice patterns in prenatal diagnosis, as well as the role of prenatal diagnosis in outcome. Data from all live births with morphologic single right ventricle and systemic outflow obstruction screened for the Pediatric Heart Network's Single Ventricle Reconstruction Trial were used to investigate prenatal diagnosis and preoperative risk factors. Demographics, gestational age, prenatal diagnosis status, presence of major extracardiac congenital abnormalities, and preoperative mortality rates were recorded. Of 906 infants, 677 (75%) had prenatal diagnosis, 15% were preterm (<37 weeks' gestation), and 16% were low birth weight (<2500 g). Rates of prenatal diagnosis varied by study site (59% to 85%, P < .0001). Major extracardiac congenital abnormalities were less prevalent in those born after prenatal diagnosis (6% vs 10%, P = .03). There were 26 (3%) deaths before Norwood palliation; preoperative mortality did not differ by prenatal diagnosis status (P = .49). In multiple logistic regression models, preterm birth (P = .02), major extracardiac congenital abnormalities (P < .0001), and obstructed pulmonary venous return (P = .02) were independently associated with preoperative mortality. Prenatal diagnosis occurred in 75%. Preoperative death was independently associated with preterm birth, obstructed pulmonary venous return, and major extracardiac congenital abnormalities. Adjusted for gestational age and the presence of obstructed pulmonary venous return, the estimated odds of preoperative mortality were 10 times greater for subjects with a major extracardiac congenital abnormality. Copyright © 2010 The American Association for Thoracic Surgery. All rights reserved.

  9. Impact of Venous Thromboembolism, Venous Stasis Syndrome, Venous Outflow Obstruction and Venous Valvular Incompetence on Quality of Life and Activities of Daily Living: A Nested Case-Control Study

    PubMed Central

    Ashrani, Aneel A.; Silverstein, Marc D.; Rooke, Thom W.; Lahr, Brian D.; Petterson, Tanya M.; Bailey, Kent R.; Melton, L. Joseph; Heit, John A.

    2010-01-01

    The role of venous stasis syndrome (VSS) mechanisms (i.e. venous outflow obstruction [VOO] and venous valvular incompetence [VVI]) on quality of life (QoL) and activities of daily living (ADL) is unknown. The objective of this study was to test the hypotheses that venous thromboembolism (VTE), VSS, VOO and VVI are associated with reduced QoL and ADL. This study is a follow-up of an incident VTE case–control study nested within a population-based inception cohort of incident residents from Olmsted County, MN, USA, between 1966 and 1990. The study comprised 232 Olmsted County residents with a first lifetime VTE and 133 residents without VTE. Methods included a questionnaire and physical examination for VSS; vascular laboratory testing for VOO and VVI; assessment of QoL by SF36 and of ADL by pertinent sections from the Older Americans Resources and Services (OARS) and Arthritis Impact Measurement Scales (AIMS2) questionnaires. Of the 365 study participants, 232 (64%), 161 (44%), 43 (12%) and 136 (37%) had VTE, VSS, VOO and VVI, respectively. Prior VTE was associated with reduced ADL and increased pain, VSS with reduced physical QoL and increased pain, and VOO with reduced physical QoL and ADL. VVI was not associated with QoL or ADL. In conclusion, VSS and VOO are associated with worse physical QoL and increased pain. VOO and VTE are associated with impaired ADL. We hypothesize that rapid clearance of venous outflow obstruction in individuals with acute VTE will improve their QoL and ADL. PMID:20926498

  10. Reduction of obstruction related bladder overactivity by the guanylyl cyclase modulators BAY 41-2272 and BAY 60-2770 alone or in combination with a phosphodiesterase type 5 inhibitor.

    PubMed

    Füllhase, C; Hennenberg, M; Sandner, P; Strittmatter, F; Niedworok, C; Bauer, R M; Gratzke, C; Soler, R; Stief, C; Andersson, K E

    2015-11-01

    To assess the urodynamic effects of soluble guanylyl cyclase (sGC) stimulator, BAY 41-2272, and activator, BAY 60-2770, (which both are able to induce cGMP synthesis even in the absence of nitric oxide (NO)) alone or in combination with a phosphodiesterase type 5 (PDE5) inhibitor, vardenafil, in a model of partial urethral obstruction (PUO) induced bladder overactivity (BO). Fifty-six male Sprague-Dawley rats were used, 31 of them underwent PUO. Fourteen rats were used for Western blots to assess PDE5 and sGC expression. For drug evaluation cystometry without anesthesia was performed three days following bladder catheterization. Obstructed rats showed higher micturition frequency and bladder pressures than non-obstructed animals (Intermicturition Interval, IMI, 2.28 ± 0.55 vs. 3.60 ± 0.60 min (± standard deviation, SD); maximum micturition pressure, MMP, 70.1 ± 8.0 vs. 48.8 ± 7.2 cmH2O; both P < 0.05). In obstructed rats vardenafil, BAY 41-2272, and BAY 60-2770 increased IMI (2.77 ± 1.12, 2.62 ± 0.52, and 3.22 ± 1.04 min; all P < 0.05) and decreased MMP (54.4 ± 2.8, 61.5 ± 11.3, and 51.2 ± 6.3 cmH2O; all P < 0.05). When vardenafil was given following BAY 41-2272 or BAY 60-2770 no further urodynamic effects were observed. PDE5 as well as sGC protein expression was reduced in obstructed bladder tissue. Targeting sGC via stimulators or activators, which increase the levels of cGMP independent of endogenous NO, is as effective as vardenafil to reduce urodynamic signs of BO. Targeting the NO/cGMP pathway via compounds acting on sGC might become a new approach to treat BO. © 2014 Wiley Periodicals, Inc.

  11. AB279. SPR-06 Fibrosis in the bladder in response to outlet obstruction is triggered through the NLRP3 inflammasome and the production of IL-1β

    PubMed Central

    Hughes, Francis M.; Govada, Vihasa; Sexton, Stephanie; Purves, J. Todd

    2016-01-01

    Objective Bladder outlet obstruction (BOO), most commonly created by benign prostatic hyperplasia, promotes an inflammatory state that produces voiding dysfunction. Recently, we have shown that the NLRP3 inflammasome triggers this inflammation. Over time, inflammation promotes fibrosis. In this study we explore the role of NLRP3 (and IL-1β produced by activated NLRP3) in BOO-induced fibrosis. Methods Rats were divided into 5 groups: (I) control, (II) sham, (III) BOO + Vehicle (Veh; 1 mL, 40% EtOH, p.o.), (IV) BOO + glyburide (Gly; NLRP3 inhibitor; 10 mg/kg, p.o.) or (V) BOO + Anakinra (Ana; IL-1 receptor antagonist; 25 mg/kg, i.p.). BOO is constructed by inserting a 1-mm transurethral catheter, tying a suture around the urethra and removing the catheter. Medications were given prior to surgery and once daily for 12 days. Hypertrophy was assessed by bladder weight, fibrosis by collagen staining (Masson’s Trichrome Stain), IL-1 receptor 1 (IL-1R1), prolyl 4-hydroylase (P4H) and lysyl oxidase (LOX) localization by immunofluorescence and collagen secretion by Sirius Red. Results BOO increased production of collagen in the bladder which was blocked by either preventing NLRP3 activation with glyburide or blocking IL-1β’s action at its receptor, clearly implicating the NLRP3/IL-1β pathway in fibrosis during BOO. IL-1β directly triggers collagen synthesis in other tissues and we found that recombinant IL-1β stimulated pro-collagen production in control urothelial cells placed in culture. Consistent with urothelia as a source of pro-collagen production, isolated urothelial cells from BOO rats secreted significantly more IL-1β than control cells. In control rats, the IL-1β receptor, IL-1R1, was highly expressed in the basal layer of the urothelia with less staining in the umbrella cells and detrusor and no staining in the interstitium. P4H (a marker of pro-collagen synthesis) exhibited similar staining, although enhanced expression in the basal urothelia was not

  12. The effective tool for self-assessment of adherence to treatment in patients with benign prostatic obstruction and overactive bladder symptoms.

    PubMed

    Kosilov, Kirill; Loparev, Sergey; Kuzina, Irina; Shakirova, Olga; Zhuravskaya, Natalya; Lobodenko, Alexandra

    2017-03-01

    Study of validity of the Medication Adherence Self-Report Inventory (MASRI) for use in clinical practice to treat patients with benign prostatic obstruction (BPO) accompanied with overactive bladder (OAB) symptoms. During 12 weeks of the randomized study, 452 patients with BPO and OAB symptoms (mean age of 61.3 (12.7)) were studied for adherence to the treatment with Tamsulosin, Solifenacin and Trospium using the MASRI. External monitoring instruments included the Brief Medication Questionnaire (BMQ) and the visual remaining pill count. The state of the prostate gland and the lower urinary tract was monitored using questionnaires I-PSS, OAB Awareness Tool, uroflowmetry and voiding diaries. Correlation between the percentage of men non-adherent to treatment (MASRI) and the percentage of patients having a belief barrier on the screen of the BMQ was r = 0.89, p ≤0.05, r = 0.92, p ≤0.01, r = 0.85, p ≤0.05, a number of missed doses on the Regimen Screen of the BMQ was r = 0.79; p ≤0.05; r = 0.81; p ≤0.05; r = 0.75, p ≤0.05, a number of non-adherent patients according to the BMQ was r = 0.83 (p ≤0.05), r = 0.88 (p ≤0.05), r = 0.79, p ≤0.05, the results of the pill count were r = 0.65-0.76; p ≤0.05-0.01. These data confirm high validity of the MASRI. The MASRI is a valid tool for rapid assessment of adherence to treatment of patients with BPO and OAB receiving Tamsulosin and antimuscarinic drugs and may be recommended for use in clinical practice.

  13. The UroCuff test: a non-invasive alternative to pressure flow studies in adult males with lower urinary tract symptoms secondary to bladder outlet obstruction.

    PubMed

    Matulewicz, Richard S; Hairston, John C

    2015-08-01

    To assure that patients with lower urinary tract symptoms (LUTS) benefit from interventions, urologists must practice careful selection of surgical candidates. Currently, 15%-30% of men do not benefit optimally from these invasive and potentially morbid procedures. Success rates following transurethral resection of the prostate (TURP) are higher if bladder outlet obstruction (BOO) is confirmed prior to the procedure by invasive pressure flow studies (PFS). However, PFS may not be performed because of many reasons. We report a study of a non-invasive method of assessing BOO. The UroCuff test was compared to invasive urodynamic studies in adult males with lower urinary tract symptoms. Patients undergoing PFS for LUTS presumed to be due to BOO were recruited from a single site to perform a penile cuff test (UroCuff) at the same time as PFS. Standard PFS were performed followed immediately by a penile cuff test in the same test setting. The results were compared using basic statistical analysis. A total of 19 men were evaluated by both PFS and UroCuff evaluation. Using PFS as the gold standard, the positive predictive value of the UroCuff penile cuff test to diagnose BOO was found to be 92%. The sensitivity of the UroCuff test for detecting BOO was 75%. When compared to PFS, patients preferred the UroCuff 100% of the time. The UroCuff test is accurate in predicting BOO when compared to conventional invasive pressure flow studies in men with LUTS. It is well tolerated and preferred over invasive pressure flow studies.

  14. Photoselective laser vaporization of the prostate in the treatment of bladder outlet obstruction in advanced-stage prostate cancer: a single-center experience.

    PubMed

    Jin, ChongRui; Xu, Yue-Min; Fu, Qiang; Gu, BaoJun

    2012-10-01

    The study in China is the first on photoselective vaporization of the prostate (PVP) applied to bladder outlet obstruction (BOO) or urinary retention from advanced-stage prostate cancer (PCa). The aim is to evaluate the efficacy and safety of PVP in the treatment of patients with BOO secondary to advanced-stage PCa. Forty-five patients (mean age 76.13±5.88 years, range 62-89 years) with BOO or urinary retention secondary to advanced-stage PCa received PVP with a potassium-titanyl-phosphate laser. The treatment outcome was evaluated with subjective and objective tests at 1, 3, 6, and 12 months after PVP using the International Prostate Symptom Score (IPSS), quality of life (QoL) score, postvoid residual (PVR) urine volume, and maximum urinary flow rate (Qmax). The operative time, indwelling catheterization time, and operative complications were also observed. All 45 patients recovered without incident. The mean operative time was 50±7.6 minutes. The catheterization duration was 3.2 days (range 2-7 days). There was significant improvement in Qmax from 7.29±0.93 to 12.16±2.75 mL/sec after treatment at 12 months. Mean PVR volume decreased from 210.94±179.49 to 54.45±33.16 mL. Mean IPSS score decreased from preoperative 28.19±3.64 to postoperative 14.61±2.81 (P<0.05), QoL score decreased from 5.03±0.69 to 3.66±0.65 (P<0.05). There were no intraoperative adverse events. Postoperative complications included mild transient hematuria in 12 (26.7%) patients and mild dysuria in 11 (24.4%) patients within 4 weeks. The clinical results suggest that PVP is a safe, efficient, and less-invasive treatment for patients with BOO or urinary retention secondary to advanced-stage PCa.

  15. [TURP plus endocrine therapy (ET) versus α1A-blockers plus ET for bladder outlet obstruction in advanced prostate cancer].

    PubMed

    Tao, Ling-song; Tao, Liang-jun; Chen, Yi-sheng; Zou, Bin; Zhu, Guang-biao; Wang, Jia-wei; Liang, Chao-zhao

    2015-07-01

    To compare the effect of transurethral resection of the prostate combined with endocrine therapy (TURP + ET) with that of αlA-blockers combined with ET ((αlA-b + ET) in the treatment of bladder outlet obstruction (BOO) in patients with advanced prostate cancer (PCa), and to investigate the safety of the TURP + ET for the treatment of PCa with BOO. We retrospectively analyzed 63 cases of PCa with BOO, 28 treated by αlA-b + ET and the other 35 by TURP + ET. We obtained the residual urine volume (RV), maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and quality of life score (QoL) before and after treatment along with the overall survival rate of the patients, followed by comparison of the parameters between the two methods. At 3 months after treatment, RV, IPSS, and QoL in the TURP + ET group were significantly decreased from (137.8 ± 27.6) ml, (22.3 ± 3.6), and (4.2 ± 0.8) to (29 ± 13.6) ml, (7.8 ± 2.1), and (1.6 ± 0.5) respectively (P < 0.05), while Qmax increased from (5.6 ± 2.1) ml/s to (17.6 ± 2.7) ml/s (P < 0.05); the former three parameters in the αlA-b + ET group decreased from (133.6 ± 24.9) ml, (21.5 ± 3.2), and (4.7 ± 1.1) to (42 ± 18.3) ml, (12.8 ± 2.6), and (2.5 ± 0.7) respectively (P < 0.05), while the latter one increased from (6.3 ± 2.4) ml/s to (11.7 ± 2.3) ml/s (P < 0.05), all with statistically significant differences between the two groups (P < 0.05). The overall survival rate of the TURP + ET group was not significantly different from that of the αlA-b + ET group (51.4% vs 46.4% , P > 0.05). TURP + ET is preferable to αlA-b + ET for its advantage of relieving BOO symptoms in advanced PCa without affecting the overall survival rate of the patients.

  16. Bladder Health

    MedlinePlus

    ... organ, much like a balloon, that stores urine. Pelvic floor muscles help hold urine in the bladder. The ... the bathroom more often. The bladder wall and pelvic floor muscles may weaken. Weak bladder wall muscles may ...

  17. Bladder Management

    MedlinePlus

    ... Catheterization • Urinary Tract Infections: Indwelling (Foley) Catheter Bladder Management [ Download this pamphlet: "Bladder Management" - (PDF, 499KB) ] The ... and medication or surgery may be helpful. Bladder Management Foley or Suprapubic Catheter A tube is inserted ...

  18. Bladder cancer

    MedlinePlus

    Transitional cell carcinoma of the bladder; Urothelial cancer ... In the United States, bladder cancer often starts from the cells lining the bladder. These cells are called transitional cells. These tumors are classified by the way ...

  19. Bladder Cancer

    MedlinePlus

    ... schistosomiasis) is a common cause of bladder infections. Adenocarcinoma. Adenocarcinoma begins in cells that make up mucus-secreting glands in the bladder. Adenocarcinoma of the bladder is rare in the United ...

  20. Bladder biopsy

    MedlinePlus

    Biopsy - bladder ... A bladder biopsy can be done as part of a cystoscopy . Cystoscopy is a telescopic examination of the inside of the ... informed consent form before you have a bladder biopsy. In most cases, you are asked to urinate ...

  1. Right ventricular outflow tract obstruction as a confounding factor in the assessment of the impact of pulmonary regurgitation on the right ventricular size and function in patients after repair of tetralogy of Fallot.

    PubMed

    Spiewak, Mateusz; Biernacka, Elżbieta K; Małek, Łukasz A; Petryka, Joanna; Kowalski, Mirosław; Miłosz, Barbara; Zabicka, Magdalena; Miśko, Jolanta; Rużyłło, Witold

    2011-05-01

    To compare right ventricular (RV) size and function between patients with combined pulmonary regurgitation (PR) plus RV outflow tract (RVOT) obstruction (RVOTO) and patients with isolated PR. Consecutive individuals with significant PR (PR fraction ≥ 20%) after tetralogy of Fallot (TOF) repair who underwent cardiovascular magnetic resonance (CMR) were included. Patients with additional hemodynamic abnormalities (residual ventricular septal defect, extracardiac shunt, and/or more than mild regurgitation at a valve other than the pulmonary valve) were excluded. Significant RVOTO was defined as peak gradient across RVOT ≥ 30 mmHg. Significant differences between patients with combined PR+RVOTO (n = 9) and isolated PR (n = 33) were observed in RV end-diastolic volume (138.6 ± 25.1 vs. 167.0 ± 34.6 mL/m(2) , P = 0.02, respectively), RV end-systolic volume (65.0 ± 9.6 vs. 92.7 ± 26.2 mL/m(2) , P = 0.003), and RV ejection fraction (RVEF) (52.8 ± 3.7 vs. 45.0 ± 6.4%, P = 0.001). Both PR and peak RVOT gradient were independent predictors of RV size. Patients with combined PR+RVOTO had smaller RV volumes and higher RVEF when compared with patients with isolated PR. The confounding effect of RVOTO on RV size and function needs to be considered in CMR studies evaluating patients after TOF repair. Copyright © 2011 Wiley-Liss, Inc.

  2. 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

  3. Epidemiology of Noncomplex Left Ventricular Outflow Tract Obstruction Malformations (Aortic Valve Stenosis, Coarctation of the Aorta, Hypoplastic Left Heart Syndrome) in Texas, 1999 –2001

    PubMed Central

    McBride, Kim L.; Marengo, Lisa; Canfield, Mark; Langlois, Peter; Fixler, David; Belmont, John W.

    2006-01-01

    BACKGROUND The left ventricular outflow tract (LVOT) malformations aortic valve stenosis (AVS), coarctation of the aorta (CoA), and hypoplastic left heart syndrome (HLHS) contribute significantly to infant mortality due to birth defects. Previous epidemiology data showed rate differences between male and female and white and black ethnic groups. The Texas Birth Defects Registry, an active surveillance program, enables study in a large, diverse population including Hispanics. METHODS Records of children up to 1 year old with AVS, CoA, and HLHS born in Texas from 1999 to 2001, were collected from the registry. Those including additional heart defects or a chromosomal anomaly were excluded. Multivariate analysis included: infant sex; United States–Mexico border county residence; and maternal age, race/ethnicity, birthplace, and education. RESULTS There were 910 cases among 1.08 million live births, of which 499 met inclusion criteria. Multivariate modeling of all LVOT malformations combined demonstrated lower prevalence rate ratios (PRRs) for black males (0.26) and Hispanic males (0.70). Similar results were found for CoA but not AVS or HLHS. Higher PRRs were noted for increased maternal age for LVOT (1.3 for 24–34 years; 1.7 for >34 years), AVS, and HLHS, but not CoA, and higher PRRs across all diagnoses for males (LVOT PRR, 2.4) were noted. CoA PRRs were higher in border county vs. non–border county residents (PRR, 2.1). Maternal education and birthplace were not significant factors. CONCLUSIONS There are rate differences for males among all 3 ethnic groups. Sex and ethnic differences suggest genetic etiologies, where the ethnic differences could be used to find susceptibility loci with mapping by admixture linkage disequilibrium. Increased CoA rates along the U.S.–Mexico border suggest environmental causes that will require further monitoring. PMID:16007587

  4. A pilot study evaluating a new questionnaire for prostatic symptom scoring, the SPSS, and its sensitivity as constructed to objective measures of outflow obstruction.

    PubMed

    Yano, Masataka; Kitahara, Satoshi; Yasuda, Kosaku; Yamanishi, Tomonori; Nakai, Hideo; Yanagisawa, Ryouzo; Morozumi, Makoto; Homma, Yukio

    2004-05-01

    To evaluate the extent to which our newly developed questionnaire, the Saitama Prostate Symptom Score (SPSS), for prostatic symptom scoring reflects objective findings in benign prostatic hyperplasia (clinical BPH) and to compare it with the International Prostate Symptom Score (IPSS) with regard to diagnostic sensitivity in clinical BPH. In this study, both the SPSS and the IPSS were self-administered by patients. Free uroflowmetry, a pressure-flow study and the measurement of prostatic volume were carried out. There was no significant correlation between the results of the IPSS questionnaire and the urethral obstruction grade estimated by Schaefer or Abrams-Griffiths nomograms. The total score of the SPSS was correlated with these nomograms (P = 0.0487 and P = 0.0413, respectively). There was no significant correlation between the results of the IPSS questionnaire and the total volume or transition zone volume of the prostate, whereas the total score of the SPSS correlated with the total volume of the gland and transition zone volume (P = 0.0044 and P= 0.0051, respectively). This study revealed the SPSS to correlate with objective findings satisfactorily. However, there are still several aspects of the SPSS which need to be improved upon, and the questionnaire should be studied in larger numbers of patients suffering from lower urinary tract symptoms.

  5. Teloscopy after bladder neck suspension.

    PubMed

    Shoemaker, E S; Wilkinson, P D

    1998-08-01

    Teloscopy, a method of suprapubic cystoscopy, involves placing a telescope into the dome of a full bladder to examine the bladder interior. A 5-mm Dexide cannula was pierced through the dome of the bladder and a telescope was inserted through it. This specialized cannula sleeve maintained bladder distention and allowed an excellent wide-angle view of the interior of the bladder and ureteral orifices. In a retrospective analysis, 103 consecutive women with stress urinary incontinence who underwent retropubic urethropexy were placed into one of three categories: Burch laparotomy (13), Burch laparoscopy (44), or laparoscopy with mesh and staples (46). Teloscopy was performed and indigo carmine was given intravenously at the end of the procedure in 90 patients. Of these, seven (8%) were positive. In all seven a suture was seen through the bladder mucosa, and in five an additional obstructed ureter was observed. In all seven women the suture was removed and replaced, and all obstructed ureters were patent before the end of the procedure. Average time required was 4 minutes. No complications, short- or long-term, occurred in the 90 women. Our results support the view that cystoscopy should be performed at the end of bladder neck suspension.

  6. Bladder Stones

    MedlinePlus

    ... the urine. The elements in urine can form crystals. These harden to create bladder stones. Bladder stones ... away from diets high in fat, salt, and sugar.Avoid smoking and illegal drugs. Your kidneys can ...

  7. Bladder cancer.

    PubMed Central

    Leung, H. Y.; Griffiths, T. R.; Neal, D. E.

    1996-01-01

    Bladder cancer is the fourth most common cancer in England and Wales. The most common presenting symptom is macroscopic haematuria. The management options for superficial and invasive bladder cancer depend on the stage at presentation. Most superficial bladder cancers are managed by transurethral resection and cytoscopic follow-up. The prognosis for patients with invasive bladder cancer is less good. The role of chemical, radiotherapeutic and surgical intervention are discussed. PMID:9015464

  8. 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

  9. 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.

  10. [Effects of electroacupuncture treatment on nitrergic neurotransmitter in bladder neck and detrusor of rats with unstable bladder].

    PubMed

    Chen, Yue-Lai; Cen, Jue; Hou, Wen-Guang; Gao, Zhi-Qiang; Yu, Xian-Min; Ma, Xue-Mei

    2006-01-01

    To observe the effects of electroacupuncture treatment on nitrergic neurotransmitter in bladder neck and detrusor of rats with unstable bladder. Rat models of unstable bladder were established by operation to induce urethral obstruction. Electroacupuncture treatment was given by acupuncturing Huiyang and Zhonglushu points for a week. Then the neuronal nitric oxide synthase (nNOS)-, endothelial nitric oxide synthase (eNOS)- and inducible nitric oxide synthase (iNOS)-positive cells in bladder neck and detrusor of the rats were observed. The nitrergic neurotransmitter in bladder neck and detrusor were obviously decreased in rats with unstable bladder. The electroacupuncture treatment could significantly increase the contains of NOS in bladder tissue. To promote the synthesis and secretion of nitrergic neurotransmitter in bladder tissue may be one of the mechanisms of acupuncture in adjusting bladder function.

  11. Bladder cancer.

    PubMed

    Sanli, Oner; Dobruch, Jakub; Knowles, Margaret A; Burger, Maximilian; Alemozaffar, Mehrdad; Nielsen, Matthew E; Lotan, Yair

    2017-04-13

    Bladder cancer is a highly prevalent disease and is associated with substantial morbidity, mortality and cost. Environmental or occupational exposures to carcinogens, especially tobacco, are the main risk factors for bladder cancer. Most bladder cancers are diagnosed after patients present with macroscopic haematuria, and cases are confirmed after transurethral resection of bladder tumour (TURBT), which also serves as the first stage of treatment. Bladder cancer develops via two distinct pathways, giving rise to non-muscle-invasive papillary tumours and non-papillary (solid) muscle-invasive tumours. The two subtypes have unique pathological features and different molecular characteristics. Indeed, The Cancer Genome Atlas project identified genetic drivers of muscle-invasive bladder cancer (MIBC) as well as subtypes of MIBC with distinct characteristics and therapeutic responses. For non-muscle-invasive bladder cancer (NMIBC), intravesical therapies (primarily Bacillus Calmette-Guérin (BCG)) with maintenance are the main treatments to prevent recurrence and progression after initial TURBT; additional therapies are needed for those who do not respond to BCG. For localized MIBC, optimizing care and reducing morbidity following cystectomy are important goals. In metastatic disease, advances in our genetic understanding of bladder cancer and in immunotherapy are being translated into new therapies.

  12. Bladder hernia.

    PubMed

    Nicola, Massimiliano; De Luca, Francesco

    2006-06-01

    Bladder hernia is a rare condition, but crural herniation of the bladder into the scrotum is very rare. A case of bladder hernia presenting with urological symptoms is described. A 71-year-old man presented to the urological ward complaining for persistent frequency and nocturia associated with loss offorce and decrease of caliber of the urinary stream and the presence of a large mass of the right scrotum. An IVP (intra venous pyelography) showed a large herniation of the bladder through the right inguinal canal into the scrotum. An inguinal incision was made and a crural hernia was identified. The hernia sac, containing bowel and bladder, was dissectedfreefrom the spermatic cord and the testis and the hernia defect was repaired.

  13. PLUTO trial protocol: percutaneous shunting for lower urinary tract obstruction randomised controlled trial.

    PubMed

    Kilby, Mark; Khan, Khalid; Morris, Katie; Daniels, Jane; Gray, Richard; Magill, Laura; Martin, Bill; Thompson, Peter; Alfirevic, Zarko; Kenny, Simon; Bower, Sarah; Sturgiss, Stephen; Anumba, Dilly; Mason, Gerald; Tydeman, Graham; Soothill, Peter; Brackley, Karen; Loughna, Pamela; Cameron, Alan; Kumar, Sailesh; Bullen, Phil

    2007-07-01

    The primary objective is to determine whether intrauterine vesicoamniotic shunting for fetal bladder outflow obstruction, compared with conservative, noninterventional care, improves prenatal and perinatal mortality and renal function. The secondary objectives are to determine if shunting for fetal bladder outflow obstruction improves perinatal morbidity, to determine if improvement in outcomes is related to prognostic assessment at diagnosis and, if possible, derive a prognostic risk index and to determine the safety and long-term efficacy of shunting. A multicentre randomised controlled trial (RCT). Fetal medicine units. Pregnant women with singleton, male fetus with isolated lower urinary tract obstruction (LUTO). Following ultrasound diagnosis of LUTO in a male fetus and exclusion of other structural and chromosomal anomalies, participation in the trial will be discussed with the mother and written information given. Consent for participation in the trial will be taken and the mother randomised via the internet to either insertion of a vesicoamniotic shunt or expectant management. During pregnancy, both groups will be followed with regular ultrasound scans looking at viability, renal measurements and amniotic fluid volume. Following delivery, babies will be followed up by paediatric nephrologists/urologists at 4-6 weeks, 12 months and 3 and 5 years to assess renal function via serum creatinine, renal ultrasound and need for dialysis/transplant. The main outcome measures will be perinatal mortality rates and renal function at 4-6 weeks and 12 months measured via serum creatinine, renal ultrasound and need for dialysis/transplant. Wellbeing of Women. ESTIMATED COMPLETION DATE: September 2010. TRIAL ALGORITHM: [flowchart: see text].

  14. Disopyramide as a negative inotrope in obstructive cardiomyopathy in children.

    PubMed

    Duncan, W J; Tyrrell, M J; Bharadwaj, B B

    1991-03-01

    Two children with left ventricular outflow tract obstruction due to myocardial hypertrophy received oral disopyramide as a negative inotrope. Both showed rapid improvement in clinical signs and by echo Doppler examination. Nearly complete abolition of severe left ventricular outflow tract obstruction was documented in each case. This experience may prompt further application of disopyramide as a therapeutic agent to relieve dynamic muscular subaortic obstruction in children.

  15. Pathogenesis of Bladder Calculi in the Presence of Urinary Stasis

    PubMed Central

    Childs, M. Adam; Mynderse, Lance A.; Rangel, Laureano J.; Wilson, Torrence M.; Lingeman, James E.; Krambeck, Amy E.

    2013-01-01

    Purpose Although minimal evidence exists, bladder calculi in men with benign prostatic hyperplasia are thought to be secondary to bladder outlet obstruction induced urinary stasis. We performed a prospective, multi-institutional clinical trial to determine whether metabolic differences were present in men with and without bladder calculi undergoing surgical intervention for benign prostatic hyperplasia induced bladder outlet obstruction. Materials and Methods Men who elected surgery for bladder outlet obstruction secondary to benign prostatic hyperplasia with and without bladder calculi were assessed prospectively and compared. Men without bladder calculi retained more than 150 ml urine post-void residual urine. Medical history, serum electrolytes and 24-hour urinary metabolic studies were compared. Results Of the men 27 had bladder calculi and 30 did not. Bladder calculi were associated with previous renal stone disease in 36.7% of patients (11 of 30) vs 4% (2 of 27) and gout was associated in 13.3% (4 of 30) vs 0% (0 of 27) (p <0.01 and 0.05, respectively). There was no observed difference in the history of other medical conditions or in serum electrolytes. Bladder calculi were associated with lower 24-hour urinary pH (median 5.9 vs 6.4, p = 0.02), lower 24-hour urinary magnesium (median 106 vs 167 mmol, p = 0.01) and increased 24-hour urinary uric acid supersaturation (median 2.2 vs 0.6, p <0.01). Conclusions In this comparative prospective analysis patients with bladder outlet obstruction and benign prostatic hyperplasia with bladder calculi were more likely to have a renal stone disease history, low urinary pH, low urinary magnesium and increased urinary uric acid supersaturation. These findings suggest that, like the pathogenesis of nephrolithiasis, the pathogenesis of bladder calculi is likely complex with multiple contributing lithogenic factors, including metabolic abnormalities and not just urinary stasis. PMID:23159588

  16. Neurogenic bladder

    MedlinePlus

    ... cause skin to break down and lead to pressure sores Kidney damage if the bladder becomes too full, ... dysfunction; NBSD Patient Instructions Multiple sclerosis - discharge Preventing pressure ulcers Images Voiding cystourethrogram References Chapple CR, Osman NI. ...

  17. Bladder Cancer Advocacy Network

    MedlinePlus

    ... Grants Bladder Cancer Think Tank Bladder Cancer Research Network Bladder Cancer Genomics Consortium Get Involved Ways to ... RESEARCHERS Research Grants Bladder Cancer Think Tank Research Network Explore all research programs View all stories NEWSLETTER ...

  18. Development of Decision Support Formulas for the Prediction of Bladder Outlet Obstruction and Prostatic Surgery in Patients With Lower Urinary Tract Symptom/Benign Prostatic Hyperplasia: Part II, External Validation and Usability Testing of a Smartphone App

    PubMed Central

    2017-01-01

    Purpose We aimed to externally validate the prediction model we developed for having bladder outlet obstruction (BOO) and requiring prostatic surgery using 2 independent data sets from tertiary referral centers, and also aimed to validate a mobile app for using this model through usability testing. Methods Formulas and nomograms predicting whether a subject has BOO and needs prostatic surgery were validated with an external validation cohort from Seoul National University Bundang Hospital and Seoul Metropolitan Government-Seoul National University Boramae Medical Center between January 2004 and April 2015. A smartphone-based app was developed, and 8 young urologists were enrolled for usability testing to identify any human factor issues of the app. Results A total of 642 patients were included in the external validation cohort. No significant differences were found in the baseline characteristics of major parameters between the original (n=1,179) and the external validation cohort, except for the maximal flow rate. Predictions of requiring prostatic surgery in the validation cohort showed a sensitivity of 80.6%, a specificity of 73.2%, a positive predictive value of 49.7%, and a negative predictive value of 92.0%, and area under receiver operating curve of 0.84. The calibration plot indicated that the predictions have good correspondence. The decision curve showed also a high net benefit. Similar evaluation results using the external validation cohort were seen in the predictions of having BOO. Overall results of the usability test demonstrated that the app was user-friendly with no major human factor issues. Conclusions External validation of these newly developed a prediction model demonstrated a moderate level of discrimination, adequate calibration, and high net benefit gains for predicting both having BOO and requiring prostatic surgery. Also a smartphone app implementing the prediction model was user-friendly with no major human factor issue. PMID:28446011

  19. Development of Decision Support Formulas for the Prediction of Bladder Outlet Obstruction and Prostatic Surgery in Patients With Lower Urinary Tract Symptom/Benign Prostatic Hyperplasia: Part II, External Validation and Usability Testing of a Smartphone App.

    PubMed

    Choo, Min Soo; Jeong, Seong Jin; Cho, Sung Yong; Yoo, Changwon; Jeong, Chang Wook; Ku, Ja Hyeon; Oh, Seung-June

    2017-04-01

    We aimed to externally validate the prediction model we developed for having bladder outlet obstruction (BOO) and requiring prostatic surgery using 2 independent data sets from tertiary referral centers, and also aimed to validate a mobile app for using this model through usability testing. Formulas and nomograms predicting whether a subject has BOO and needs prostatic surgery were validated with an external validation cohort from Seoul National University Bundang Hospital and Seoul Metropolitan Government-Seoul National University Boramae Medical Center between January 2004 and April 2015. A smartphone-based app was developed, and 8 young urologists were enrolled for usability testing to identify any human factor issues of the app. A total of 642 patients were included in the external validation cohort. No significant differences were found in the baseline characteristics of major parameters between the original (n=1,179) and the external validation cohort, except for the maximal flow rate. Predictions of requiring prostatic surgery in the validation cohort showed a sensitivity of 80.6%, a specificity of 73.2%, a positive predictive value of 49.7%, and a negative predictive value of 92.0%, and area under receiver operating curve of 0.84. The calibration plot indicated that the predictions have good correspondence. The decision curve showed also a high net benefit. Similar evaluation results using the external validation cohort were seen in the predictions of having BOO. Overall results of the usability test demonstrated that the app was user-friendly with no major human factor issues. External validation of these newly developed a prediction model demonstrated a moderate level of discrimination, adequate calibration, and high net benefit gains for predicting both having BOO and requiring prostatic surgery. Also a smartphone app implementing the prediction model was user-friendly with no major human factor issue.

  20. 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. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. 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.

  2. Intestinal Obstruction

    MedlinePlus

    An intestinal obstruction occurs when food or stool cannot move through the intestines. The obstruction can be complete or partial. ... abdomen Inability to pass gas Constipation A complete intestinal obstruction is a medical emergency. It often requires surgery. ...

  3. 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.

  4. FOREIGN BODY IN URINARY BLADDER: AN UNUSUAL PRESENTATION.

    PubMed

    Hashmi, Saadat-Hassan; Khan, Ikramullah

    2015-01-01

    Urinary bladder functions for the storage and expulsion of urine. Foreign bodies in male urinary bladder are rare due to lengthy urethra, especially when they are rounded in shape and difficult to be introduced into urinary bladder. This is a case report of a middle age male with thin body habitus and slightly disturbed psychiatric status. He presented with both irritative and obstructive lower urinary tract symptoms (LUTS). He was investigated and found to have an intact bangle in the urinary bladder. The patient was planned for surgery, and the foreign body was removed endoscopically with the help of cystoscope. Later on the patient was referred to a psychiatrist for psychological management.

  5. Continuous bladder irrigation in the monoplace hyperbaric chamber: Two case reports.

    PubMed

    Cooper, Jeffrey S; Allinson, Peter; Winn, Dana; Keim, Lon; Sippel, Joe; Shalberg, Patty; Fowler, Kari

    2015-01-01

    Radiation-induced hemorrhagic cystitis is a serious side effect of radiation therapy. Anemia requiring transfusion can ensue. Treatment methods include bladder irrigation, fulguration, and hyperbaric oxygen (HBO2) therapy. Failure of treatment leads to cystectomy associated with a high risk of severe complications (42%) and mortality (16%). Continuous bladder irrigation (CBI) is often required to prevent further clot formation. HBO2 supports the healing process of radiation cystitis. In patients requiring CBI, the time in HBO2 can help cause clot accumulation and obstruction. We describe a method of providing CBI in a monoplace hyperbaric chamber. An IV to catheter adapter is used, allowing an IV pump to control CBI flow into the chamber. Drainage is collected in an extra-large (2- to 5-liter) bag. The rate is set so the volume does not exceed the bag's capacity. The bag is placed in a manner that precludes spilling and allows monitoring of outflow. CBI was successfully maintained. Brief cases are presented and issues discussed. CBI is easily maintained in a monoplace hyperbaric chamber, with readily available equipment allowing for uninterrupted CBI of hemorrhagic cystitis. HBO2 helps mitigate the potential side effects of other interventions in a previously irradiated area.

  6. 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.

  7. 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.

  8. 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.

  9. 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

  10. Bilateral Obstructive Uropathy Secondary to Giant Periureteral Diverticulum

    PubMed Central

    San Jose Manso, Luis Alberto; Olivier Gomez, Carlos; Silmi Moyano, Angel Nellyt

    2013-01-01

    Bladder diverticula are herniations of the mucosa through the fibers of the bladder muscle connected by necks of variable amplitude. They are often asymptomatic, although they may lead to complications that require a surgical therapeutic approach. We report the case of a patient with bilateral obstructive uropathy secondary to a giant periureteral diverticulum that was treated by diverticulectomy and reimplantation of the left ureter in the bladder. PMID:24251064

  11. A Shocking Outflow

    NASA Image and Video Library

    2010-07-28

    This image shows an outflow of gas from a new star as it jets from a space object dubbed IRAS 21078+5211. The reddish blob in its center, as picked up by NASA Spitzer Space Telescope contrasts nicely with the clouds, colored green, that surround it.

  12. 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.

  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. GALAXY OUTFLOWS WITHOUT SUPERNOVAE

    SciTech Connect

    Sur, Sharanya; Scannapieco, Evan; Ostriker, Eve C. E-mail: sharanya.sur@asu.edu

    2016-02-10

    High surface density, rapidly star-forming galaxies are observed to have ≈50–100 km s{sup −1} line of sight velocity dispersions, which are much higher than expected from supernova driving alone, but may arise from large-scale gravitational instabilities. Using three-dimensional simulations of local regions of the interstellar medium, we explore the impact of high velocity dispersions that arise from these disk instabilities. Parametrizing disks by their surface densities and epicyclic frequencies, we conduct a series of simulations that probe a broad range of conditions. Turbulence is driven purely horizontally and on large scales, neglecting any energy input from supernovae. We find that such motions lead to strong global outflows in the highly compact disks that were common at high redshifts, but weak or negligible mass loss in the more diffuse disks that are prevalent today. Substantial outflows are generated if the one-dimensional horizontal velocity dispersion exceeds ≈35 km s{sup −1}, as occurs in the dense disks that have star-formation rate (SFR) densities above ≈0.1 M{sub ⊙} yr{sup −1} kpc{sup −2}. These outflows are triggered by a thermal runaway, arising from the inefficient cooling of hot material coupled with successive heating from turbulent driving. Thus, even in the absence of stellar feedback, a critical value of the SFR density for outflow generation can arise due to a turbulent heating instability. This suggests that in strongly self-gravitating disks, outflows may be enhanced by, but need not caused by, energy input from supernovae.

  15. 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

  16. [Disorders of bladder compliance and neurogenic bladder].

    PubMed

    Chartier-Kastler, E; Comperat, E; Ruffion, A

    2007-05-01

    Bladder compliance is defined as the relationship between change in bladder volume and change in detrusor pressure (DV/DP). The pathophysiology of neurogenic disorders of bladder compliance is still poorly understood. Experimental reduction of blood flow in the bladder wall, bilateral hypogastric nerve section in rats, the study of spinalized rat bladders, and reduction of oestrogen impregnation show that these conditions induce loss of the viscoelastic properties of the bladder. With the arrival of new treatments active on afferent and/or efferent pathways or on the central nervous system, it is very important to improve our understanding of the pathophysiology of neurogenic disorders of bladder compliance. The reversibility of these disorders constitutes a major therapeutic challenge and their functional consequences constitute a crucial prognostic element of neurogenic bladder. Disorders of bladder compliance can be assessed clinically from two points of view: 1) The natural history of onset of these disorders in neurogenic bladder. Clinical experience demonstrates certain risk factors for the development of these disorders, such as the voiding mode (intermittent self-catheterization or by a carer versus indwelling catheter), the level of the spinal cord lesion (suprasacral versus sacral, incomplete versus complete, and cauda equina lesions), and the presence of myelomeningocele. 2) Data derived from conservative management of these disorders in patients with neurogenic bladder: urethral dilatation, various types of sphincterotomy, vesical denervation, alpha-blockers, sympatholytics, vanilloids (resiniferatoxin and capsaicin), intra-detrusor botulinum toxin and intrathecal baclofen have been shown to improve disorders of compliance of neurogenic bladder.

  17. An unusual cause of death: spontaneous urinary bladder perforation.

    PubMed

    Limon, Onder; Unluer, Erden Erol; Unay, Fulya Cakalagaoglu; Oyar, Orhan; Sener, Aslı

    2012-11-01

    Spontaneous urinary bladder perforation is a rare and life-threatening condition similar to traumatic and iatrogenic perforation. The connection with the underlying bladder damage due to previous radiotherapy, inflammation, malignancy, obstruction, or other causes can be found in almost all cases. The symptoms are often nonspecific, and misdiagnosis is common. Here, we present a case of spontaneous urinary bladder perforation due to bladder necrosis in a diabetic woman. She presented to the emergency department with abdominal pain. Exploratory laparotomy was performed by surgeons and revealed necrosis of the anterior and lateral walls of the urinary bladder. Microscopic examination revealed necrotic changes throughout the bladder wall. Ghost-like cellular outlines were compatible with coagulative necrosis. Clusters of bacteria were also present in some necrobiotic tissues. Malignant cells were not present. It appears probable that the infection was due to local interference with the blood supply (arterial, capillary, or venous) combined with the systemic metabolic upset that led to the bladder condition. In our case, we observed partial necrosis of the bladder rather than distortion of the entire blood supply to the bladder as consequences of the microvascular effects of diabetes. Urinary bladder perforation must be considered in the differential diagnosis of patients presenting with free fluid in the abdomen/peritonitis, decreased urine output, and hematuria, and in whom increased levels of urea/creatinine are detected in serum and/ or peritoneal fluid aspirate.

  18. Chryse Outflow Channel

    NASA Image and Video Library

    1998-06-08

    A color image of the south Chryse basin Valles Marineris outflow channels on Mars; north toward top. The scene shows on the southwest corner the chaotic terrain of the east part of Valles Marineris and two of its related canyons: Eos and Capri Chasmata (south to north). Ganges Chasma lies directly north. The chaos in the southern 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 NASA's Viking medium-resolution images in black and white and low-resolution images in color. The image extends from latitude 20 degrees S. to 20 degrees N. and from longitude 15 degrees to 53 degrees; Mercator projection. http://photojournal.jpl.nasa.gov/catalog/PIA00418

  19. 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

  20. 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.

  1. The mass and momentum outflow rates of photoionized galactic outflows

    NASA Astrophysics Data System (ADS)

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

    2017-08-01

    Galactic outflows are believed to play an important role in regulating star formation in galaxies, but estimates of the outflowing mass and momentum have historically been based on uncertain assumptions. Here, we measure the mass, momentum and energy outflow rates of seven nearby star-forming galaxies using ultraviolet absorption lines and observationally motivated estimates for the density, metallicity, and radius of the outflow. Low-mass galaxies generate outflows faster than their escape velocities with mass outflow rates up to twenty times larger than their star formation rates. These outflows from low-mass galaxies also have momenta larger than provided from supernovae alone, indicating that multiple momentum sources drive these outflows. Only 1-20 per cent of the supernovae energy is converted into kinetic energy, and this fraction decreases with increasing stellar mass, such that low-mass galaxies drive more efficient outflows. We find scaling relations between the outflows and the stellar mass of their host galaxies (M*) at the 2-3σ significance level. The mass-loading factor, or the mass outflow rate divided by the star formation rate, scales as M_\\ast ^{-0.4} and with the circular velocity as v_circ^{-1.6}. The scaling of the mass-loading factor is similar to recent simulations, but the observations are a factor of 5 smaller, possibly indicating that there is a substantial amount of unprobed gas in a different ionization phase. The outflow momenta are consistent with a model where star formation drives the outflow while gravity counteracts this acceleration.

  2. Stem Cell Therapy in Bladder Dysfunction: Where Are We? And Where Do We Have to Go?

    PubMed Central

    Lee, Sang-Rae; Song, Yun Seob; Lee, Hong Jun

    2013-01-01

    To date, stem cell therapy for the bladder has been conducted mainly on an experimental basis in the areas of bladder dysfunction. The therapeutic efficacy of stem cells was originally thought to be derived from their ability to differentiate into various cell types. Studies about stem cell therapy for bladder dysfunction have been limited to an experimental basis and have been less focused than bladder regeneration. Bladder dysfunction was listed in MESH as “urinary bladder neck obstruction”, “urinary bladder, overactive”, and “urinary bladder, neurogenic”. Using those keywords, several articles were searched and studied. The bladder dysfunction model includes bladder outlet obstruction, cryoinjured, diabetes, ischemia, and spinal cord injury. Adipose derived stem cells (ADSCs), bone marrow stem cells (BMSCs), and skeletal muscle derived stem cells (SkMSCs) are used for transplantation to treat bladder dysfunction. The main mechanisms of stem cells to reconstitute or restore bladder dysfunction are migration, differentiation, and paracrine effects. The aim of this study is to review the stem cell therapy for bladder dysfunction and to provide the status of stem cell therapy for bladder dysfunction. PMID:24151627

  3. A case-control study on the association between bladder cancer and prior bladder calculus.

    PubMed

    Chung, Shiu-Dong; Tsai, Ming-Chieh; Lin, Ching-Chun; Lin, Herng-Ching

    2013-03-15

    Bladder calculus is associated with chronic irritation and inflammation. As there is substantial documentation that inflammation can play a direct role in carcinogenesis, to date the relationship between stone formation and bladder cancer (BC) remains unclear. This study aimed to examine the association between BC and prior bladder calculus using a population-based dataset. This case-control study included 2,086 cases who had received their first-time diagnosis of BC between 2001 and 2009 and 10,430 randomly selected controls without BC. Conditional logistic regressions were employed to explore the association between BC and having been previously diagnosed with bladder calculus. Of the sampled subjects, bladder calculus was found in 71 (3.4%) cases and 105 (1.1%) controls. Conditional logistic regression analysis revealed that the odds ratio (OR) of having been diagnosed with bladder calculus before the index date for cases was 3.42 (95% CI = 2.48-4.72) when compared with controls after adjusting for monthly income, geographic region, hypertension, diabetes, coronary heart disease, and renal disease, tobacco use disorder, obesity, alcohol abuse, and schistosomiasis, bladder outlet obstruction, and urinary tract infection. We further analyzed according to sex and found that among males, the OR of having been previously diagnosed with bladder calculus for cases was 3.45 (95% CI = 2.39-4.99) that of controls. Among females, the OR was 3.05 (95% CI = 1.53-6.08) that of controls. These results add to the evidence surrounding the conflicting reports regarding the association between BC and prior bladder calculus and highlight a potential target population for bladder cancer screening.

  4. UPJ obstruction

    MedlinePlus

    ... of urinary tract obstruction. In: Wein AJ, ed. Campbell-Walsh Urology . 10th ed. Philadelphia, PA: Elsevier Saunders; ... of urinary tract obstruction. In: Wein AJ, ed. Campbell-Walsh Urology . 10th ed. Philadelphia, PA: Elsevier Saunders; ...

  5. Intestinal obstruction

    MedlinePlus

    Paralytic ileus; Intestinal volvulus; Bowel obstruction; Ileus; Pseudo-obstruction - intestinal; Colonic ileus ... objects that are swallowed and block the intestines) Gallstones (rare) Hernias Impacted stool Intussusception (telescoping of 1 ...

  6. Intestinal Obstruction

    MedlinePlus

    ... Wall Hernias Inguinal Hernia Acute Mesenteric Ischemia Appendicitis Ileus Intestinal Obstruction Ischemic Colitis Perforation of the Digestive ... Wall Hernias Inguinal Hernia Acute Mesenteric Ischemia Appendicitis Ileus Intestinal Obstruction Ischemic Colitis Perforation of the Digestive ...

  7. Evaluation and management of outlet obstruction in women without anatomical abnormalities on physical exam or cystoscopy.

    PubMed

    Hickling, Duane; Aponte, Margarita; Nitti, Victor

    2012-10-01

    Bladder outlet obstruction (BOO) in women can be either anatomic or functional. Anatomic causes for BOO are often readily apparent by history and physical exam. On the other hand, causes for functional obstruction, including dysfunctional voiding, primary bladder neck obstruction, and detrusor-external sphincter dyssynergia, are more difficult to establish. Because the appropriate treatment for functional obstruction drastically varies according to etiology, making an accurate diagnosis is paramount. Videourodynamics, interpreted in the context of individual clinical symptoms, remains the diagnostic gold standard in women with functional obstruction.

  8. The concept of peripheral modulation of bladder sensation

    PubMed Central

    Eastham, Jane E; Gillespie, James I

    2013-01-01

    It is recognized that, as the bladder fills, there is a corresponding increase in sensation. This awareness of the volume in the bladder is then used in a complex decision making process to determine if there is a need to void. It is also part of everyday experience that, when the bladder is full and sensations strong, these sensations can be suppressed and the desire to void postponed. The obvious explanation for such altered perceptions is that they occur centrally. However, this may not be the only mechanism. There are data to suggest that descending neural influences and local factors might regulate the sensitivity of the systems within the bladder wall generating afferent activity. Specifically, evidence is accumulating to suggest that the motor-sensory system within the bladder wall is influenced in this way. The motor-sensory system, first described over 100 years ago, appears to be a key component in the afferent outflow, the afferent “noise,” generated within the bladder wall. However, the presence and possible importance of this complex system in the generation of bladder sensation has been overlooked in recent years. As the bladder fills the motor activity increases, driven by cholinergic inputs and modulated, possibly, by sympathetic inputs. In this way information on bladder volume can be transmitted to the CNS. It can be argued that the ability to alter the sensitivity of the mechanisms generating the motor component of this motor-sensory system represents a possible indirect way to influence afferent activity and so the perception of bladder volume centrally. Furthermore, it is emerging that the apparent modulation of sensation by drugs to alleviate the symptoms of overactive bladder (OAB), the anti-cholinergics and the new generation of drugs the β3 sympathomimetics, may be the result of their ability to modulate the motor component of the motor sensory system. The possibility of controlling sensation, physiologically and pharmacologically, by

  9. The concept of peripheral modulation of bladder sensation.

    PubMed

    Eastham, Jane E; Gillespie, James I

    2013-01-01

    It is recognized that, as the bladder fills, there is a corresponding increase in sensation. This awareness of the volume in the bladder is then used in a complex decision making process to determine if there is a need to void. It is also part of everyday experience that, when the bladder is full and sensations strong, these sensations can be suppressed and the desire to void postponed. The obvious explanation for such altered perceptions is that they occur centrally. However, this may not be the only mechanism. There are data to suggest that descending neural influences and local factors might regulate the sensitivity of the systems within the bladder wall generating afferent activity. Specifically, evidence is accumulating to suggest that the motor-sensory system within the bladder wall is influenced in this way. The motor-sensory system, first described over 100 years ago, appears to be a key component in the afferent outflow, the afferent "noise," generated within the bladder wall. However, the presence and possible importance of this complex system in the generation of bladder sensation has been overlooked in recent years. As the bladder fills the motor activity increases, driven by cholinergic inputs and modulated, possibly, by sympathetic inputs. In this way information on bladder volume can be transmitted to the CNS. It can be argued that the ability to alter the sensitivity of the mechanisms generating the motor component of this motor-sensory system represents a possible indirect way to influence afferent activity and so the perception of bladder volume centrally. Furthermore, it is emerging that the apparent modulation of sensation by drugs to alleviate the symptoms of overactive bladder (OAB), the anti-cholinergics and the new generation of drugs the β 3 sympathomimetics, may be the result of their ability to modulate the motor component of the motor sensory system. The possibility of controlling sensation, physiologically and pharmacologically, by

  10. 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

  11. Isolated bladder aspergillosis as the primary presentation of non-oliguric acute renal failure.

    PubMed

    Dervisoglu, Erkan; Dikmen, Emre; Filinte, Deniz; Yilmaz, Ahmet

    2008-01-01

    A 70-year-old male patient with diabetes mellitus presented to our hospital with acute obstructive non-oliguric renal failure. Abdominal CT revealed obstructive hydronephrosis and irregular thickening of the bladder wall. Upon cystoscopy, samples of tissue were taken and found to be positive for Aspergillus spp. on histology, indicating infection of the bladder wall. The patient was treated successfully by means of a percutaneous nephrostomy and a 30-day course of caspofungin.

  12. 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.

  13. Chryse Outflow Channel

    NASA Technical Reports Server (NTRS)

    1997-01-01

    A color image of the south Chryse basin Valles Marineris outflow channels on Mars; north toward top. The scene shows on the southwest corner the chaotic terrain of the east part of Valles Marineris and two of its related canyons: Eos and Capri Chasmata (south to north). Ganges Chasma lies directly north. The chaos in the southern 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. The image extends from latitude 20 degrees S. to 20 degrees N. and from longitude 15 degrees to 53 degrees; Mercator projection.

    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 a chaotic material, and ends in Simud Valles. Tiu and Simud Valles consist of a complex of connected channel floors and chaotic terrain and extend as far south as and connect to eastern Valles Marineris. Ares Vallis originates from discontinuous patches of chaotic terrain within large craters. In the Chryse basin the Ares channel forks; one branch continues northwest into central Chryse Planitia (Latin for plain) and the other extends north into eastern Chryse Planitia.

  14. Chryse Outflow Channel

    NASA Technical Reports Server (NTRS)

    1997-01-01

    A color image of the south Chryse basin Valles Marineris outflow channels on Mars; north toward top. The scene shows on the southwest corner the chaotic terrain of the east part of Valles Marineris and two of its related canyons: Eos and Capri Chasmata (south to north). Ganges Chasma lies directly north. The chaos in the southern 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. The image extends from latitude 20 degrees S. to 20 degrees N. and from longitude 15 degrees to 53 degrees; Mercator projection.

    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 a chaotic material, and ends in Simud Valles. Tiu and Simud Valles consist of a complex of connected channel floors and chaotic terrain and extend as far south as and connect to eastern Valles Marineris. Ares Vallis originates from discontinuous patches of chaotic terrain within large craters. In the Chryse basin the Ares channel forks; one branch continues northwest into central Chryse Planitia (Latin for plain) and the other extends north into eastern Chryse Planitia.

  15. Male overactive bladder: the role of urodynamics and anticholinergics.

    PubMed

    MacDiarmid, Scott; Rogers, Alexandra

    2007-01-01

    Millions of men suffer from overactive bladder and lower urinary tract symptoms. The adverse effects on quality of life and costs associated with the condition have been well described. In men, the pathophysiology of lower urinary tract symptoms may be from a number of causes including bladder outlet obstruction, detrusor overactivity, or both. Increasing data and clinical experience support the efficacy and safety of anticholinergics in men; the rate of urinary retention has been equal to that of placebo in short-term studies. Urodynamics play a vital role in defining the bladder and/or outlet dysfunction and help direct one's therapy.

  16. Multiple Uric Acid Bladder Stones: Clinical Presentation and Endoscopic Management

    PubMed Central

    Torricelli, Fabio Cesar Miranda; Chueh, Shih-Chieh Jeff; Shen, Shujane

    2017-01-01

    Abstract Background: Bladder urinary calculi occur in 3%–8% of men with bladder outlet obstruction, and although most of them are composed of calcium, in a few cases uric acid bladder stones are diagnosed. Case Presentation: We present clinical images and therapeutic management of a 65-year-old diabetic man with significant prostate enlargement and >30 bladder stones, the largest being 17 mm. Despite the large stone burden, the patient was managed by cystolithotripsy. Remarkably, stone composition analysis revealed 100% uric acid stone. Intraoperative and postoperative course were uneventfully. Conclusion: Uric acid bladder stone pathogenesis seems to be multifactorial with local and systemic factors contributing in different manners and even large stone burdens may be cystoscopically managed. PMID:28265592

  17. Obstructive Sleep Apnea

    MedlinePlus

    ... to find out more. Obstructive Sleep Apnea Obstructive Sleep Apnea Obstructive sleep apnea (OSA) is a serious ... to find out more. Obstructive Sleep Apnea Obstructive Sleep Apnea Obstructive sleep apnea (OSA) is a serious ...

  18. Bladder sensation measures and overactive bladder.

    PubMed

    Rapp, David E; Neil, Nancy J; Govier, Fred E; Kobashi, Kathleen C

    2009-09-01

    We performed a prospective multicomponent study to determine whether subjective and objective bladder sensation instruments may provide data on sensory dysfunction in patients with overactive bladder. We evaluated 70 prospectively enrolled patients with urodynamics and questionnaires on validated urgency (Urgency Perception Score), general overactive bladder (Urogenital Distress Inventory) and quality of life (Incontinence Impact Questionnaire). We first sought a correlation between sensory specific (Urgency Perception Score) and quality of life questionnaire scores. We then assessed a correlation between sensory questionnaire scores and urodynamic variables, exploring the hypothesis that certain urodynamic parameters may be bladder sensation measures. We evaluated 2 urodynamic derivatives (first sensation ratio and bladder urgency velocity) to increase sensory finding discrimination. We noted a moderate correlation between the Urgency Perception Score (0.56) and the Urogenital Distress Inventory (0.74) vs the Incontinence Impact Questionnaire (each p <0.01). A weak negative correlation was seen between Urgency Perception Score and bladder capacity (-0.25, p <0.05). No correlation was noted for the other urodynamics parameters. First sensation ratio and bladder urgency velocity statistically significantly correlated with the Urgency Perception Score despite the lesser or absent correlation associated with the individual components of these derivatives. Bladder sensation questionnaires may be valuable to identify patients with sensory dysfunction and provide additional data not obtained in generalized symptom questionnaires. Urodynamic variables correlated with bladder sensation questionnaire scores and may be an objective method to assess sensory dysfunction.

  19. Obstructive uropathy

    MedlinePlus

    ... PA: Elsevier Saunders; 2016:chap 123. Read More Acute Bladder stones Cervical cancer Chronic Colon cancer Cystinuria Endometrial cancer Enlarged prostate Hydronephrosis of one kidney Renal Retroperitoneal fibrosis Review Date 3/28/2016 Updated ...

  20. 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 ...

  1. 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.

  2. 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

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

    PubMed

    Yeniel, Ahmet Özgür; Ergenoğlu, Mete Ahmet; Meseri, Reci; Aşkar, Niyazi; Itil, Ismail Mete

    2012-01-01

    To determine the relationship between overactive bladder symptoms and urodynamic verification of overactive bladder. 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. 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). 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.

  4. 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.

  5. Bilateral Hydroureteronephrosis with a Hypertrophied, Trabeculated Urinary Bladder

    PubMed Central

    Iqbal, Showkathali; Raiz, Iqbal; Faiz, Iqbal

    2017-01-01

    Bilateral hydroureteronephrosis involves the dilatation of the renal pelvis, calyces and ureter; it develops secondary to urinary tract obstruction and leads to a build-up of back pressure in the urinary tract, and it may lead to impairment of renal function and ultimately culminate in renal failure. Although clinically silent in most cases, it can be diagnosed as an incidental finding during evaluation of an unrelated cause. In a minority of patients, it presents with signs and symptoms. Renal calculus is the most common cause, but there are multiple non-calculus aetiologies, and they depend on age and sex. Pelviureteric junction obstruction, benign prostatic hypertrophy, urethral stricture, neurogenic bladder, retroperitoneal mass and bladder outlet obstruction are some of the frequent causes of hydroureteronephrosis in adults. The incidence of non-calculus hydronephrosis is more common in males than in females. Ultrasonography is the most important baseline investigation in the evaluation of patients with hydronephrosis. Here, we report a rarely seen case of bilateral hydroureteronephrosis associated with a hypertrophied, trabeculated bladder in an adult male cadaver, suspected to be due to a primary bladder neck obstruction, and analyse its various other causes, clinical presentations and outcomes. PMID:28894411

  6. Experimental evaluation of urinary bladder marsupialization in male goats.

    PubMed

    May, Kimberly A; Moll, H David; Duncan, Robert B; Moon, Martha M; Pleasant, R Scott; Howard, Rick D

    2002-01-01

    To evaluate the outcome of urinary bladder marsupialization in male goats. Prospective, experimental study. Six healthy mixed-breed male goats. After experimentally induced urethral obstruction, 6 male goats had urinary bladder marsupialization. Renal ultrasonography, complete blood count, and serum biochemical analysis were evaluated preoperatively (day 0), at 7 postoperative days, and then at 30-day intervals until 180 days. Stomal diameter was recorded immediately postoperatively and at each postoperative interval. Necropsy examination was performed on day 180 or when stomal stricture or death occurred. Stomal stricture occurred in 1 goat at 120 days. Another goat was found dead at 150 days; severe, suppurative cystitis was identified on necropsy. All goats had mild urine scald dermatitis. Serum biochemical values remained within normal limits, but significant decreases in white blood cell count, serum creatinine concentration, and stomal diameter occurred. At necropsy, all bladders were tubular in shape. Histological evidence of chronic suppurative cystitis and chronic, mild lymphoplasmacytic pyelitis occurred in all goats. Bacterial culture of renal tissue yielded growth in 3 goats, and bladder mucosal swabs yielded bacterial growth in all goats. Although clinical signs of ascending urinary tract infection were not observed in goats with patent stomata, urinary bladder marsupialization may result in ascending urinary tract inflammation or infection. Based on our results, urinary bladder marsupialization should be recommended with caution as the primary method for management of urinary tract obstruction in clinical cases. Copyright 2002 by The American College of Veterinary Surgeons

  7. 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

  8. RADIATIVE TRANSFER IN ULTRARELATIVISTIC OUTFLOWS

    SciTech Connect

    Beloborodov, Andrei M.

    2011-08-20

    Analytical and numerical solutions are obtained for the equation of radiative transfer in ultrarelativistic opaque jets. The solution describes the initial trapping of radiation, its adiabatic cooling, and the transition to transparency. Two opposite regimes are examined. (1) Matter-dominated outflow. Surprisingly, radiation develops enormous anisotropy in the fluid frame before decoupling from the fluid. The radiation is strongly polarized. (2) Radiation-dominated outflow. The transfer occurs as if radiation propagated in vacuum, preserving the angular distribution and the blackbody shape of the spectrum. The escaping radiation has a blackbody spectrum if (and only if) the outflow energy is dominated by radiation up to the photospheric radius.

  9. Auroral arcs and ion outflow

    NASA Astrophysics Data System (ADS)

    Maggiolo, Romain

    2016-04-01

    This presentation provides an overwiew of the chapter "Auroral Arcs and Ion Outflow" from the AGU book "Auroral Dynamics and Space Weather" (eds Y. Zhang and L. J. Paxton). This topic covers a wide range of domains, from auroral acceleration processes, auroral arc morphology and dynamics to global magnetosphere-ionosphere coupling and atmospheric erosion. This presentation mainly focuses on the observational properties of auroral ion outflow. Recent observations about their large-scale spatial distribution and link with auroral forms will be presented. Auroral ion outflow statistical dependence on solar and geomagnetic activity and its modulation by auroral dynamics at the timescale of substorms will also be discussed.

  10. 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

  11. 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

  12. Energy exchanges in reconnection outflows

    NASA Astrophysics Data System (ADS)

    Lapenta, Giovanni; Goldman, Martin V.; Newman, David L.; Markidis, Stefano

    2017-01-01

    Reconnection outflows are highly energetic directed flows that interact with the ambient plasma or with flows from other reconnection regions. Under these conditions the flow becomes highly unstable and chaotic, as any flow jets interacting with a medium. We report here massively parallel simulations of the two cases of interaction between outflow jets and between a single outflow with an ambient plasma. We find in both case the development of a chaotic magnetic field, subject to secondary reconnection events that further complicate the topology of the field lines. The focus of the present analysis is on the energy balance. We compute each energy channel (electromagnetic, bulk, thermal, for each species) and find where the most energy is exchanged and in what form. The main finding is that the largest energy exchange is not at the reconnection site proper but in the regions where the outflowing jets are destabilized.

  13. Urofacial syndrome: A subset of neurogenic bladder dysfunction syndromes?

    PubMed Central

    Stamatiou, K. N.; Karakos, C. D.

    2010-01-01

    The urofacial syndrome is probably a subset of neurogenic bladder dysfunction syndromes characterized by detrusor-sphincter discoordination along with a characteristic inversion of facial expression with laughing. This characteristic facial expression can facilitate early detection of this disorder, which leads to poor bladder emptying with high residual urine, hydro-nephrosis with vesico-ureteral reflux and potentially renal failure if left untreated. The etiology of the urofacial syndrome is unknown. In our case, a 12-year-old boy of Middle-Eastern origin presented to the Outpatient Department of our hospital with left pyelonephritis, hydronephrosis and bladder dilatation. Voiding cystourethrography performed 15 days later revealed left vesicoureteral reflux. Cystoscopy revealed bladder trabeculation however an anatomic urethral obstruction was not noticed. Both, neurological examination and radiography of the lumbosacral spine were normal. Urodynamic evaluation revealed the typical findings of detrusor-sphincter discoordination. PMID:21369396

  14. Urofacial syndrome: A subset of neurogenic bladder dysfunction syndromes?

    PubMed

    Stamatiou, K N; Karakos, C D

    2010-10-01

    The urofacial syndrome is probably a subset of neurogenic bladder dysfunction syndromes characterized by detrusor-sphincter discoordination along with a characteristic inversion of facial expression with laughing. This characteristic facial expression can facilitate early detection of this disorder, which leads to poor bladder emptying with high residual urine, hydro-nephrosis with vesico-ureteral reflux and potentially renal failure if left untreated. The etiology of the urofacial syndrome is unknown. In our case, a 12-year-old boy of Middle-Eastern origin presented to the Outpatient Department of our hospital with left pyelonephritis, hydronephrosis and bladder dilatation. Voiding cystourethrography performed 15 days later revealed left vesicoureteral reflux. Cystoscopy revealed bladder trabeculation however an anatomic urethral obstruction was not noticed. Both, neurological examination and radiography of the lumbosacral spine were normal. Urodynamic evaluation revealed the typical findings of detrusor-sphincter discoordination.

  15. Shining a light on galactic outflows: photoionized outflows

    NASA Astrophysics Data System (ADS)

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

    2016-04-01

    We study the ionization structure of galactic outflows in 37 nearby, star-forming galaxies with the Cosmic Origins Spectrograph on the Hubble Space Telescope. We use the O I, Si II, Si III, and Si IV ultraviolet absorption lines to characterize the different ionization states of outflowing gas. We measure the equivalent widths, line widths, and outflow velocities of the four transitions, and find shallow scaling relations between them and galactic stellar mass and star formation rate. Regardless of the ionization potential, lines of similar strength have similar velocities and line widths, indicating that the four transitions can be modelled as a comoving phase. The Si equivalent width ratios (e.g. Si IV/Si II) have low dispersion, and little variation with stellar mass; while ratios with O I and Si vary by a factor of 2 for a given stellar mass. Photoionization models reproduce these equivalent width ratios, while shock models under predict the relative amount of high ionization gas. The photoionization models constrain the ionization parameter (U) between -2.25 < log (U) < -1.5, and require that the outflow metallicities are greater than 0.5 Z⊙. We derive ionization fractions for the transitions, and show that the range of ionization parameters and stellar metallicities leads to a factor of 1.15-10 variation in the ionization fractions. Historically, mass outflow rates are calculated by converting a column density measurement from a single metal ion into a total hydrogen column density using an ionization fraction, thus mass outflow rates are sensitive to the assumed ionization structure of the outflow.

  16. SVC obstruction

    MedlinePlus

    ... Other causes of superior vena cava obstruction include: Aortic aneurysm (a widening of the artery that leaves the ... nlm.nih.gov/pubmed/17476012 . Read More Abdominal aortic aneurysm Chronic Histoplasmosis Lung cancer - small cell Pericarditis - constrictive ...

  17. 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.

  18. Biomatrices for bladder reconstruction.

    PubMed

    Lin, Hsueh-Kung; Madihally, Sundar V; Palmer, Blake; Frimberger, Dominic; Fung, Kar-Ming; Kropp, Bradley P

    2015-03-01

    There is a demand for tissue engineering of the bladder needed by patients who experience a neurogenic bladder or idiopathic detrusor overactivity. To avoid complications from augmentation cystoplasty, the field of tissue engineering seeks optimal scaffolds for bladder reconstruction. Naturally derived biomaterials as well as synthetic and natural polymers have been explored as bladder substitutes. To improve regenerative properties, these biomaterials have been conjugated with functional molecules, combined with nanotechology, or seeded with exogenous cells. Although most studies reported complete and functional bladder regeneration in small-animal models, results from large-animal models and human clinical trials varied. For functional bladder regeneration, procedures for biomaterial fabrication, incorporation of biologically active agents, introduction of nanotechnology, and application of stem-cell technology need to be standardized. Advanced molecular and medical technologies such as next generation sequencing and magnetic resonance imaging can be introduced for mechanistic understanding and non-invasive monitoring of regeneration processes, respectively.

  19. Development of an animal model to study congenital urinary obstruction.

    PubMed

    Pringle, K C; Kitagawa, H; Seki, Y; Koike, J; Zuccollo, J

    2013-10-01

    We outline the development of a reliable model of obstructive uropathy in fetal lambs highlighting our understanding of the critical time points for interventions and the variability of any such model. We identify some discoveries that may have clinical implications. The model requires 60-day-gestation fetal lambs. In lambs, glomerulogenesis is complete by 90 days gestation. (Term is 145 days.) The ability to develop a reliable method of creating bladder outlet obstruction in females, ligating both the urethra and urachus was critical. The lambs are bred to an accuracy of ±24 h. Creating the model at 50-60 days gestation, produces different expressions of renal dysplasia in groups of lambs undergoing identical interventions at the same stage of gestation. Early complete urethral obstruction can produce the Potter phenotype. An appropriately timed vesico-amniotic shunt preserves renal development, producing a shrunken, non-compliant bladder. Shunting the normal fetal bladder at 80 days gestation produces a similar bladder. Provision of a low-pressure valve in the shunt preserves bladder development and compliance. Using a high-pressure shunt produces results similar to non-shunted lambs. We developed a reliable animal model for obstructive uropathy. Being alert to peripheral results can lead to new findings.

  20. 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

  1. [Radiotherapy of bladder cancer].

    PubMed

    Riou, O; Chauvet, B; Lagrange, J-L; Martin, P; Llacer Moscardo, C; Charissoux, M; Lauche, O; Aillères, N; Fenoglietto, P; Azria, D

    2016-09-01

    Surgery (radical cystectomy) is the standard treatment of muscle-invasive bladder cancer. Radiochemotherapy has risen as an alternative treatment option to surgery as part as organ-sparing combined modality treatment or for patients unfit for surgery. Radiochemotherapy achieves 5-year bladder intact survival of 40 to 65% and 5-year overall survival of 40 to 50% with excellent quality of life. This article introduces the French recommendations for radiotherapy of bladder cancer: indications, exams, technique, dosimetry, delivery and image guidance.

  2. Unilateral ureteral obstruction: beyond obstruction.

    PubMed

    Ucero, Alvaro C; Benito-Martin, Alberto; Izquierdo, Maria C; Sanchez-Niño, Maria D; Sanz, Ana B; Ramos, Adrian M; Berzal, Sergio; Ruiz-Ortega, Marta; Egido, Jesus; Ortiz, Alberto

    2014-04-01

    Unilateral ureteral obstruction is a popular experimental model of renal injury. However, the study of the kidney response to urinary tract obstruction is only one of several advantages of this model. Unilateral ureteral obstruction causes subacute renal injury characterized by tubular cell injury, interstitial inflammation and fibrosis. For this reason, it serves as a model both of irreversible acute kidney injury and of events taking place during human chronic kidney disease. Being a unilateral disease, it is not useful to study changes in global kidney function, but has the advantage of a low mortality and the availability of an internal control (the non-obstructed kidney). Experimental unilateral ureteral obstruction has illustrated the molecular mechanisms of apoptosis, inflammation and fibrosis, all three key processes in kidney injury of any cause, thus providing information beyond obstruction. Recently this model has supported key concepts on the role in kidney fibrosis of epithelial-mesenchymal transition, tubular epithelial cell G2/M arrest, the anti-aging hormone Klotho and renal innervation. We now review the experimental model and its contribution to identifying novel therapeutic targets in kidney injury and fibrosis, independently of the noxa.

  3. Mechanical stretch upregulates proteins involved in Ca2+ sensitization in urinary bladder smooth muscle hypertrophy.

    PubMed

    Boopathi, Ettickan; Gomes, Cristiano; Zderic, Stephen A; Malkowicz, Bruce; Chakrabarti, Ranjita; Patel, Darshan P; Wein, Alan J; Chacko, Samuel

    2014-09-15

    Partial bladder outlet obstruction (pBOO)-induced remodeling of bladder detrusor smooth muscle (DSM) is associated with the modulation of cell signals regulating contraction. We analyzed the DSM from obstructed murine urinary bladders for the temporal regulation of RhoA GTPase and Rho-activated kinase (ROCK), which are linked to Ca(2+) sensitization. In addition, the effects of equibiaxial cell stretch, a condition thought to be associated with pBOO-induced bladder wall smooth muscle hypertrophy and voiding frequency, on the expression of RhoA, ROCK, and C-kinase-activated protein phosphatase I inhibitor (CPI-17) were investigated. DSM from 1-, 3-, 7-, and 14-day obstructed male mice bladders and benign prostatic hyperplasia (BPH)-induced obstructed human bladders revealed overexpression of RhoA and ROCK-β at the mRNA and protein levels compared with control. Primary human bladder myocytes seeded onto type I collagen-coated elastic silicone membranes were subjected to cyclic equibiaxial stretch, mimicking the cellular mechanical stretch in the bladder in vivo, and analyzed for the expression of RhoA, ROCK-β, and CPI-17. Stretch caused a significant increase of RhoA, ROCKβ, and CPI-17 expression. The stretch-induced increase in CPI-17 expression occurs at the transcriptional level and is associated with CPI-17 promoter binding by GATA-6 and NF-κB, the transcription factors responsible for CPI-17 gene transcription. Cell stretch caused by bladder overdistension in pBOO is the likely mechanism for initiating overexpression of the signaling proteins regulating DSM tone.

  4. Mechanical stretch upregulates proteins involved in Ca2+ sensitization in urinary bladder smooth muscle hypertrophy

    PubMed Central

    Boopathi, Ettickan; Gomes, Cristiano; Zderic, Stephen A.; Malkowicz, Bruce; Chakrabarti, Ranjita; Patel, Darshan P.; Wein, Alan J.

    2014-01-01

    Partial bladder outlet obstruction (pBOO)-induced remodeling of bladder detrusor smooth muscle (DSM) is associated with the modulation of cell signals regulating contraction. We analyzed the DSM from obstructed murine urinary bladders for the temporal regulation of RhoA GTPase and Rho-activated kinase (ROCK), which are linked to Ca2+ sensitization. In addition, the effects of equibiaxial cell stretch, a condition thought to be associated with pBOO-induced bladder wall smooth muscle hypertrophy and voiding frequency, on the expression of RhoA, ROCK, and C-kinase-activated protein phosphatase I inhibitor (CPI-17) were investigated. DSM from 1-, 3-, 7-, and 14-day obstructed male mice bladders and benign prostatic hyperplasia (BPH)-induced obstructed human bladders revealed overexpression of RhoA and ROCK-β at the mRNA and protein levels compared with control. Primary human bladder myocytes seeded onto type I collagen-coated elastic silicone membranes were subjected to cyclic equibiaxial stretch, mimicking the cellular mechanical stretch in the bladder in vivo, and analyzed for the expression of RhoA, ROCK-β, and CPI-17. Stretch caused a significant increase of RhoA, ROCKβ, and CPI-17 expression. The stretch-induced increase in CPI-17 expression occurs at the transcriptional level and is associated with CPI-17 promoter binding by GATA-6 and NF-κB, the transcription factors responsible for CPI-17 gene transcription. Cell stretch caused by bladder overdistension in pBOO is the likely mechanism for initiating overexpression of the signaling proteins regulating DSM tone. PMID:25031021

  5. Primary amyloid heart disease presenting as hypertrophic obstructive cardiomyopathy

    SciTech Connect

    Weston, L.T.; Raybuck, B.D.; Robinowitz, M.; Brinker, J.A.; Oetgen, W.J.

    1986-01-01

    This report describes the unusual presentation of a patient with primary cardiac amyloidosis. Initial clinical symptoms and hemodynamic studies, including Technetium-99m-pyrophosphate scintigraphy, suggested hypertrophic obstructive cardiomyopathy, but endomyocardial biopsy revealed diffuse amyloid infiltration. Only two other cases of left ventricular outflow tract obstruction due to cardiac amyloidosis have been reported. The false-negative technetium-99m-pyrophosphate scintigram in this patient argues for the use of endomyocardial biopsy to aid in the diagnosis of left ventricular hypertrophy.

  6. Positional Right Ventricular Obstruction in Pectus Excavatum.

    PubMed

    Underwood, Katherine; Vorsanger, Matthew; Saric, Muhamed; Skolnick, Adam H

    2017-04-15

    Pectus excavatum is one of the most common congenital chest wall deformities. The degree of sternal depression, which may result in compression of the right heart by the chest wall, is variable. While typically asymptomatic, there are various symptoms that can result from severe pectus excavatum. We report on a patient with severe pectus excavatum leading to dynamic obstruction of the right ventricular outflow tract in the seated position.

  7. Mediterranean outflow mixing and dynamics.

    PubMed

    Price, J F; Baringer, M O; Lueck, R G; Johnson, G C; Ambar, I; Parrilla, G; Cantos, A; Kennelly, M A; Sanford, T B

    1993-02-26

    The Mediterranean Sea produces a salty, dense outflow that is strongly modified by entrainment as it first begins to descend the continental slope in the eastern Gulf of Cadiz. The current accelerates to 1.3 meters per second, which raises the internal Froude number above 1, and is intensely turbulent through its full thickness. The outflow loses about half of its density anomaly and roughly doubles its volume transport as it entrains less saline North Atlantic Central water. Within 100 kilometers downstream, the current is turned by the Coriolis force until it flows nearly parallel to topography in a damped geostrophic balance. The mixed Mediterranean outflow continues westward, slowly descending the continental slope until it becomes neutrally buoyant in the thermocline where it becomes an important water mass.

  8. Addressing ketamine bladder syndrome.

    PubMed

    Logan, Karen

    The rise in ketamine misuse means more health professionals will need to diagnose, refer and treat ketamine bladder syndrome. Prevention and raising awareness of the problem among multidisciplinary teams will help limit damage to the bladder as well as making treatment and management more effective.

  9. Molecular Outflows: Explosive versus Protostellar

    NASA Astrophysics Data System (ADS)

    Zapata, Luis A.; Schmid-Burgk, Johannes; Rodríguez, Luis F.; Palau, Aina; Loinard, Laurent

    2017-02-01

    With the recent recognition of a second, distinctive class of molecular outflows, namely the explosive ones not directly connected to the accretion–ejection process in star formation, a juxtaposition of the morphological and kinematic properties of both classes is warranted. By applying the same method used in Zapata et al., and using 12CO(J = 2-1) archival data from the Submillimeter Array, we contrast two well-known explosive objects, Orion KL and DR21, to HH 211 and DG Tau B, two flows representative of classical low-mass protostellar outflows. At the moment, there are only two well-established cases of explosive outflows, but with the full availability of ALMA we expect that more examples will be found in the near future. The main results are the largely different spatial distributions of the explosive flows, consisting of numerous narrow straight filament-like ejections with different orientations and in almost an isotropic configuration, the redshifted with respect to the blueshifted components of the flows (maximally separated in protostellar, largely overlapping in explosive outflows), the very-well-defined Hubble flow-like increase of velocity with distance from the origin in the explosive filaments versus the mostly non-organized CO velocity field in protostellar objects, and huge inequalities in mass, momentum, and energy of the two classes, at least for the case of low-mass flows. Finally, all the molecular filaments in the explosive outflows point back to approximately a central position (i.e., the place where its “exciting source” was located), contrary to the bulk of the molecular material within the protostellar outflows.

  10. Giant bladder diverticulum presenting with recurrent acute urinary retention--a rare event in adult patients: case report.

    PubMed

    Petito, Luigi; Lurati, Massimo; Verbo, Alessandro; Manno, Alberto; Pedretti, Giorgio; Coco, Claudio

    2006-01-01

    Acquired giant bladder diverticula of obstructive genesis are not particularly unusual. On the other hand, acute urinary retention due to bladder diverticula is an extremely rare event in adult patients, since most cases are paediatric. A 40-year-old white male with a history of invasive urological procedures presented with recurrent acute urinary retention. Diagnostic procedures including cystourethrography and cystoscopy revealed a giant bladder diverticulum causing ab extrinseco compression of the urethra. The iatrogenic aetiology of the vicious circle of chronic urethral obstruction and increased luminal pressure promoting diverticular growth is discussed.

  11. Outflow from a Nocturnal Thunderstorm.

    DTIC Science & Technology

    1980-11-01

    P AD-A093 796 ILLINOIS STATE WATER SURVEY URBANAF/ .2 OUTFLOW FROM A NOCTURNAL THUNDERSTORM. (U) NOV a0 R W SCOTT NSF-ATHN78-0a865 UNCLASSIFIED SWS...CR-242 ARO-15529.5-6S N I muuuuuuuuuuuu iDA0937 9 6 State Water Survey Division k istitute of METEOROLOGY SECTION 0 uJD AT THE UNIVERSITY OF ILLINOIS...SWS Contract Report 242 / F OUTFLOW FROM A NOCTURNAL THUNDERSTORM Robert W. Scott Meteorology Section Illinois State Water Survey -- DTIC ELECTE CD

  12. 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.

  13. Blocking of the Hepatic Vein Outflow by Neointima Covering a Wallstent Across a Membranous Stenosis of the Inferior Vena Cava

    SciTech Connect

    Dutta, Usha; Garg, Pramod K.; Agarwal, Rajeev; Gupta, S. Dutta; Prasad, G. A.; Kaul, Upendra; Tandon, Rakesh K.

    1999-11-15

    A 31-year-old man presented with idiopathic membranous obstruction of the suprahepatic inferior vena cava (IVC) and was treated by balloon dilation and placement of a Wallstent. The patient improved markedly. However, he developed obstruction of the hepatic vein outflow secondary to neointima formation over the stent that covered the hepatic vein ostia. The patient died of liver failure and septicemia. We believe that this is the first report of such a serious complication.

  14. Development of a CFD urethral model to study flow-generated vortices under different conditions of prostatic obstruction.

    PubMed

    Pel, Johan J M; van Mastrigt, Ron

    2007-01-01

    A novel, non-invasive method to diagnose bladder outlet obstruction involves the recording of noise with a contact microphone pressed against the perineum (between anus and scrotum). This noise results from flow-generated vortices caused by prostatic obstruction. We developed a computational fluid dynamic (CFD) urethral model including urethral geometry to study the relation between generated noise and the degree of obstruction. This model comprised a bladder, bladder neck, prostate and urethra. Calculations were carried out at four bladder pressures, five degrees of obstruction and three obstruction shapes. For each of the sixty simulations, the velocity and pressure distributions along the urethra were calculated including wall shear stresses to localize flow transition from disturbed to normal. Negative pressures at the obstruction outlet induced recirculation of flow. The location of transition was independent of the applied bladder pressure, but it depended primarily on the degree and secondarily on the shape of the obstruction. Based on the presented results, we hypothesize that the location of the maximum amplitude of perineal noise mainly depends on the degree and shape of the prostatic obstruction. Our future aim is to test our hypothesis in male patients and to extend the presented model to 3D with a viscoelastic urethral wall to calculate the fluid-wall interaction.

  15. Molecular outflows in starburst nuclei

    NASA Astrophysics Data System (ADS)

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

    2016-12-01

    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 disc with mid-plane density n0 ˜ 200-1000 cm-3 and scaleheight 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 an SFR surface density of 10 ≤ ΣSFR ≤ 50 M⊙ yr-1 kpc-2 favours the production of molecular outflows, consistent with observed values.

  16. Origins of Bladder Cancer.

    PubMed

    Czerniak, Bogdan; Dinney, Colin; McConkey, David

    2016-05-23

    Bladder cancer, one of the most frequently occurring human cancers, develops via two tracks referred to as papillary and nonpapillary that correspond to clinically different forms of the disease. Most bladder cancers are chemically induced, with tobacco smoking being the leading risk factor. Recent advances in bladder cancer research have enhanced our understanding of the origin of this disease from urothelial progenitor cells via field effects along papillary/luminal and nonpapillary/basal pathways. Evident from the outset of the disease, the diversity of the luminal and basal pathways, together with cell lineage tracing studies, postulates the origin of molecularly distinct subtypes from different uroprogenitor cells. The molecular mechanisms initiating field effects involve a new class of genes referred to as forerunner (FR) genes that generally map around major tumor suppressors such as RB1. These genes are silenced, predominantly by hypermethylation and less frequently by mutations, and drive the expansion of intraurothelial preneoplastic cells. Different FR genes are involved in various molecular subtypes of bladder cancer and they sensitize the uroprogenitor cells to the development of luminal and basal bladder cancers in animal models. In human bladder cancer, luminal and basal forms have dissimilar clinical behavior and response to conventional and targeted chemotherapeutic manipulations. These new research developments hold the promise of expanding our armamentarium of diagnostic and treatment options for patients with bladder cancer and improving our ability to select patients most likely to respond to a specific therapy.

  17. 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.

  18. 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.

  19. [Pelvic lipomatosis. A case with ureteral and venous obstruction].

    PubMed

    Pocholle, P; Chautard, D; Bali, B; François, O; Deen, M; Soret, J Y

    1991-10-01

    The authors report a case of pelvic lipomatosis in a 62 year old man associated with venous obstruction (third case reported in the literature), diagnosed after bilateral ureteric obstruction, and review of the literature on this subject. The diagnosis was suggested by the radiological triad of hyperlucency of the pelvis on plain abdominal X-ray, "hot air balloon" appearance of the bladder on IVU and a rigid and ascended rectosigmoid on barium enema, and was confirmed by CT and MRI. Treatment combining corticosteroids and urinary tract disinfection was partially effective. A double J ureteric stent resolved the problem of persistent right ureteric obstruction.

  20. Location matters: left heart obstruction in pregnancy.

    PubMed

    Fuchs, Margaret; Zaidi, Ali N; Rose, Justin; Sisk, Tracey; Daniels, Curt J; Bradley, Elisa A

    2016-01-01

    Left heart obstruction in pregnancy is associated with higher rates of morbidity/mortality. The primary aim of this study was to evaluate maternal cardiovascular, obstetric, and fetal/infant events in pregnant women with left heart obstruction. Pregnant women with current or repaired left heart obstruction were retrospectively analyzed (2000-2014): mitral stenosis, left ventricular outflow tract obstruction (subvalvar, valvar, supravalvar), and coarctation of the aorta. Maternal cardiovascular events were defined as: heart failure, arrhythmia, urgent/emergent cardiac surgery or percutaneous transcatheter intervention, transient ischemic attack/cerebrovascular accident, and death up to 6 months postpartum. There were 90 pregnancies in 67 women (29±7 years old) who had 15 maternal cardiovascular events. Isolated mitral stenosis (n=6) or >1 serial left heart obstructive lesion (n=6) were the source of the event in the majority pregnancies. Women with isolated mitral stenosis had increased cardiovascular events compared to other single left heart obstructive lesions (OR 18.6, 95% CI: 3.8-91.1). If >1 serial obstructive lesion was present, there was also an increased risk of maternal cardiovascular events (OR 6.8, 95% CI: 1.6-29.1), however isolated mitral stenosis carried similar risk to serial left heart obstructive lesions (OR 2.7, 95% CI: 0.7-11.2). Baseline characteristics associated with events included: New York Heart Association functional class >2 (27% vs. 0, p<0.001), any current left heart obstruction (73% vs. 36%, p=0.01), severe left heart obstruction (40% vs. 29%, p<0.001), and higher Cardiac Disease in Pregnancy ("CARPREG") score (1.2±0.7 vs. 0.5±0.7, p=0.01). There was no difference in rate of obstetric/fetal/infant complications in women with cardiovascular events; however, term birth weight was lower (2.7±0.5 vs. 3.1±0.6kg, p=0.01). There was no maternal mortality. Isolated mitral stenosis and serial (>1) left heart obstructive lesions carry the

  1. ["Pathophysiology and treatment of the overactive bladder"].

    PubMed

    Yokoyama, Osamu

    2005-09-01

    The International Continence Society (ICS) recently derived a consensus symptomatic definition of overactive bladder (OAB) as urinary urgency, with or without urge incontinence, usually with frequency and nocturia. These symptom combinations are suggestive of urodynamically demonstrable detrusor overactivity. The etiology of OAB falls into two broad categories: neurogenic and nonneurogenic. It is not easy to confirm the etiology of OAB in patients with bladder outlet obstruction and neurological disease. This debate has attempted to examine the pathophysiology of OAB and to determine the optimal treatment strategy in a patient with two diseases possibly causing OAB. A 75-year-old man visited our hospital due to symptoms of OAB (urgency, nocturia, and urge incontinence) occurring after cerebrovascular accidents. Urge incontinence worsened concomitantly with the appearance of turbid urine. Urinary tract infection was accompanied by 84 ml of post-void residual. The prostate volume and PSA value were 28 ml and 1.2 ng/ml, respectively. The total International Prostate Symptom Score (IPSS) and Quality of Life (QOL) Index were 23 and 5, respectively. IPSS for storage symptoms was higher than that for obstructive symptoms. The maximum flow rate, measured after treatment for UTI, was 9.4 ml/s. Two debaters discuss the treament modality, TURP, or pharmacotherapy.

  2. 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 ...

  3. What Is Bladder Cancer?

    MedlinePlus

    ... bladder, which is called the urothelium or transitional epithelium . As the cancer grows into or through the ... in the inner layer of cells (the transitional epithelium) but have not grown into the deeper layers. ...

  4. 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 ...

  5. Bladder Diseases - Multiple Languages

    MedlinePlus

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Bladder Diseases URL of this page: https://medlineplus.gov/languages/bladderdiseases.html Other topics A-Z Expand Section ...

  6. THE COMPLETE SURVEY OF OUTFLOWS IN PERSEUS

    SciTech Connect

    Arce, Hector G.; Borkin, Michelle A.; Goodman, Alyssa A.; Pineda, Jaime E.; Halle, Michael W.

    2010-06-01

    We present a study on the impact of molecular outflows in the Perseus molecular cloud complex using the COMPLETE Survey large-scale {sup 12}CO(1-0) and {sup 13}CO(1-0) maps. We used three-dimensional isosurface models generated in right ascension-declination-velocity space to visualize the maps. This rendering of the molecular line data allowed for a rapid and efficient way to search for molecular outflows over a large ({approx}16 deg{sup 2}) area. Our outflow-searching technique detected previously known molecular outflows as well as new candidate outflows. Most of these new outflow-related high-velocity features lie in regions that have been poorly studied before. These new outflow candidates more than double the amount of outflow mass, momentum, and kinetic energy in the Perseus cloud complex. Our results indicate that outflows have significant impact on the environment immediately surrounding localized regions of active star formation, but lack the energy needed to feed the observed turbulence in the entire Perseus complex. This implies that other energy sources, in addition to protostellar outflows, are responsible for turbulence on a global cloud scale in Perseus. We studied the impact of outflows in six regions with active star formation within Perseus of sizes in the range of 1-4 pc. We find that outflows have enough power to maintain the turbulence in these regions and enough momentum to disperse and unbind some mass from them. We found no correlation between outflow strength and star formation efficiency (SFE) for the six different regions we studied, contrary to results of recent numerical simulations. The low fraction of gas that potentially could be ejected due to outflows suggests that additional mechanisms other than cloud dispersal by outflows are needed to explain low SFEs in clusters.

  7. Engineering functional bladder tissues.

    PubMed

    Horst, Maya; Madduri, Srinivas; Gobet, Rita; Sulser, Tullio; Milleret, Vinzent; Hall, Heike; Atala, Anthony; Eberli, Daniel

    2013-07-01

    End stage bladder disease can seriously affect patient quality of life and often requires surgical reconstruction with bowel tissue, which is associated with numerous complications. Bioengineering of functional bladder tissue using tissue-engineering techniques could provide new functional tissues for reconstruction. In this review, we discuss the current state of this field and address different approaches to enable physiologic voiding in engineered bladder tissues in the near future. In a collaborative effort, we gathered researchers from four institutions to discuss the current state of functional bladder engineering. A MEDLINE® and PubMed® search was conducted for articles related to tissue engineering of the bladder, with special focus on the cells and biomaterials employed as well as the microenvironment, vascularisation and innervation strategies used. Over the last decade, advances in tissue engineering technology have laid the groundwork for the development of a biological substitute for bladder tissue that can support storage of urine and restore physiologic voiding. Although many researchers have been able to demonstrate the formation of engineered tissue with a structure similar to that of native bladder tissue, restoration of physiologic voiding using these constructs has never been demonstrated. The main issues hindering the development of larger contractile tissues that allow physiologic voiding include the development of correct muscle alignment, proper innervation and vascularization. Tissue engineering of a construct that will support the contractile properties that allow physiologic voiding is a complex process. The combination of smart scaffolds with controlled topography, the ability to deliver multiple trophic factors and an optimal cell source will allow for the engineering of functional bladder tissues in the near future. Copyright © 2012 John Wiley & Sons, Ltd.

  8. 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

  9. 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.

  10. Congenital Urinary Tract Obstruction: The Long View

    PubMed Central

    Chevalier, Robert L.

    2015-01-01

    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 renal injury. Due to 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 MRI 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

  11. Intravesical therapy for overactive bladder.

    PubMed

    Evans, Robert J

    2005-11-01

    Overactive bladder and urgency incontinence are common conditions generally treated with oral anticholinergic therapy. Despite the development of new antimuscarinic agents, many patients do not tolerate or fail to respond to oral therapy. Intravesical instillation therapy can provide an alternative method of managing bladder overactivity. Intravesical instillation of anticholinergics such as oxybutynin and atropine can achieve cholinergic blockade without producing systemic side effects. Botulinum A toxin injected directly into the detrusor has been shown in preliminary studies to increase bladder capacity and decrease uncontrolled bladder contractility for up to 6 months. Intravesical local anesthetics such as lidocaine and bupivacaine block the conduction of unmyelinated C fibers and when administered into the bladder, lead to an increase in functional bladder capacity. Intravesical capsaicin and resiniferatoxin also affect afferent innervation by blocking C-fiber afferents, leading to decreased bladder contractility and increased bladder capacity. Intravesical instillation therapy can provide an alternative treatment for the management of overactive bladder.

  12. Microtomographic analysis of lower urinary tract obstruction.

    PubMed

    Siebert, Joseph R; Smith, Kenneth J; Cox, Liza L; Glass, Ian A; Cox, Timothy C

    2013-01-01

    Prenatal obstruction of the lower urinary tract may result in megacystis, with subsequent development of hydroureter, hydronephrosis, and renal damage. Oligo- or anhydramnios, pulmonary hypoplasia, and prune belly syndrome are lethal consequences. Causes and mechanisms responsible for obstruction remain unclear but might be clarified by anatomic study at autopsy. To this end, we employed 2 methods of tomographic imaging-optical projection tomography and contrast-enhanced microCT scanning-to elucidate the anatomy of the intact urinary bladder and urethra in 10 male fetuses with lower urinary tract obstruction. Images were compared with those from 9 age-matched controls. Three-dimensional images, rotated and sectioned digitally in multiple planes, permitted thorough examination while preserving specimens for later study. Both external and internal features of the bladder and urethra were demonstrated; small structures (ie, urethral crest, verumontanum, prostatic utricle, ejaculatory ducts) were seen in detail. Types of obstruction consisted of urethral atresia (n  =  5), severe urethral stenosis (n  =  2), urethral diaphragm (n  =  2), or physical kinking (n  =  1); classic (Young type I) posterior urethral valves were not encountered. Traditional light microscopy was then used to verify tomographic findings. The prostate gland was hypoplastic or absent in all cases; in 1, prostatic tissue was displaced inferior to the verumontanum. Findings support previous views that dissection may produce valve-like artifacts (eg, bisection of an obstructing diaphragm) and that deformation of an otherwise normal urethra may result in megacystis. The designation "posterior urethral valves" should not be used as a generic expression of urethral obstruction unless actual valves are demonstrated.

  13. Narrow UV Absorption Line Outflows from Quasars

    NASA Astrophysics Data System (ADS)

    Hamann, F.; Simon, L.; Rodriguez Hidalgo, P.; Capellupo, D.

    2012-08-01

    Narrow absorption line (NAL) outflows are an important yet poorly understood part of the quasar outflow phenomenon. We discuss one particular NAL outflow that has high speeds, time variability, and moderate ionizations like typical BAL flows, at an estimated location just ˜5 pc from the quasar. It also has a total column density and line widths (internal velocity dispersions) ˜100 times smaller than BALs, with no substantial X-ray absorption. We argue that radiative shielding (in the form of an X-ray/warm absorber) is not critical for the outflow acceleration and that the moderate ionizations occur in dense substructures that have an overall small volume filling factor in the flow. We also present new estimates of the overall incidence of quasar outflow lines; e.g., ˜43% of bright quasars have a C IV NAL outflow while ˜68% have a C IV outflow line of any variety (NAL, BAL, or mini-BAL).

  14. Carcinoma transverse colon masquerading as carcinoma gall bladder.

    PubMed

    Munghate, Anand; Kumar, Ashwani; Singh, Harnam; Singh, Gurpreet; Singh, Bimaljot; Chauhan, Mahak

    2014-04-01

    Colorectal cancer is one of the most common cancer worldwide .Its incidence is reported to be increasing in developing countries. It commonly presents with weight loss, anaemia, lump abdomen, change of bowel habit, obstruction or fresh rectal bleeding. Beside these common modes of presentations, there are some rare manifestations which masqueraded as different disease like obstructive jaundice, empyema gall bladder or cholecystitis. A 60-year-old male presented to hospital with right sided pain abdomen. On abdominal examination mild tenderness was present in right hypochondrium. Intra operatively gall bladder was separated from the adjoining gut, peritoneum and liver bed and was removed. On further exploration, there was a large mass in the vicinity of the gall bladder related to transverse colon. Extended right hemicolectomy was done. Histopathological examination of gut mass revealed adenocarcinoma of transverse colon with free margins and gall bladder showed cholecystitis with no evidence of malignancy. We present an interesting case of colon cancer colon that caused diagnostic confusion by mimicking as cholecystitis. Colorectal cancer constitutes a major public health issue globally. Therefore, public awareness, screening of high-risk populations, early diagnosis and effective treatment and follow-up will help to reduce its occurance and further complications.

  15. 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 ...

  16. Rapidly Growing Right Ventricular Outflow Tract Mass in Patient with Sarcomatoid Renal Cell Carcinoma

    PubMed Central

    Hwang, Jongmin; Choi, Kyung Un; Kim, Jeong Su; Hwang, Ki Won; Lee, Sang Hyun; Chon, Min Ku; Lee, Soo Yong; Lee, Dae Sung

    2016-01-01

    Cardiac metastasis from renal cell carcinoma (RCC) without inferior vena cava (IVC) involvements is extremely rare with few reported cases. Sarcomatoid RCC with rhabdoid feature is a rare pathologic type of RCC having aggressive behavior due to great metastatic potential. Here, we report a case of rapidly growing cardiac metastasis of RCC which brought on right ventricular outflow tract (RVOT) obstruction without IVC and right atrial involvement in a 61-year-old woman. Cardiac arrest occurred during radical nephrectomy and echocardiography revealed mass nearly obstructing the RVOT which was not recognized by preoperative echocardiography 1 month ago. Postoperative immunohistochemical evaluation of renal mass revealed sarcomatoid RCC with rhabdoid feature. PMID:28090262

  17. Bowel Obstruction: Sonographic Evaluation.

    PubMed

    Hollerweger, A; Wüstner, M; Dirks, K

    2015-06-01

    Learning objectives: Sonographic examination concept in the case of suspicion of bowel obstruction. Recognition of the sonographic criteria of a bowel obstruction. Ability to detect the level of a bowel obstruction. Sonographic detection of typical causes of bowel obstruction. Detection of sonographic signs of complicated bowel obstruction. Ability to sonographically define important differential diagnoses. Further diagnostic procedures in unclear situations.

  18. The Other Bladder Syndrome: Underactive Bladder

    PubMed Central

    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. PMID:23671401

  19. Role of the pelvic floor in bladder neck opening and closure I: muscle forces.

    PubMed

    Petros, P E; Ulmsten, U

    1997-01-01

    The aim of the study was to identify the striated muscle forces hypothesized to assist bladder neck opening and closure in females. Cadaveric dissection was used to identify the levator plate (LP), the anterior portion of pubococcygeus muscle (PCM), the longitudinal muscle of the anus (LMA), and their relation to the bladder, vagina and rectum. X-ray video recordings were made during coughing, straining, squeezing and micturition in a group of 20 incontinent patients and 4 controls, along with surface EMG, urethral pressure and digital palpation studies. During effort, urethral closure appeared to be activated by a forward muscle force corresponding to PCM, and bladder neck closure by backward muscle forces corresponding to LP and LMA. During micturition the PCM force appeared to relax, allowing LP and LMA to pull open the outflow tract. The data appear to support the hypothesis of specific directional muscle forces stretching the vagina to assist bladder neck opening and closure.

  20. 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

  1. Bladder Control and Nerve Disease

    MedlinePlus

    ... the sphincter muscles relax to allow urine to pass through the urethra as the bladder contracts to ... contract at the same time, so urine cannot pass easily. Drug therapy for an uncoordinated bladder and ...

  2. Giant Intradiverticular Bladder Tumor

    PubMed Central

    Noh, Mohamad Syafeeq Faeez Md; Aziz, Ahmad Fuad Abdul; Ghani, Khairul Asri Mohd; Siang, Christopher Lee Kheng; Yunus, Rosna; Yusof, Mubarak Mohd

    2017-01-01

    Patient: Male, 74 Final Diagnosis: Giant intradiverticular bladder tumor with metastasis Symptoms: Hematuria Medication:— Clinical Procedure: — Specialty: Urology Objective: Rare disease Background: Intradiverticular bladder tumors are rare. This renders diagnosis of an intradiverticular bladder tumor difficult. Imaging plays a vital role in achieving the diagnosis, and subsequently staging of the disease. Case Report: A 74-year-old male presented to our center with a few months history of constitutional symptoms. Upon further history, he reported hematuria two months prior to presentation, which stopped temporarily, only to recur a few days prior to coming to the hospital. The patient admitted to having lower urinary tract symptoms. However, there was no dysuria, no sandy urine, and no fever. Palpation of his abdomen revealed a vague mass at the suprapubic region, which was non tender. In view of his history and the clinical examination findings, an ultrasound of the abdomen and computed tomography (CT) was arranged. These investigations revealed a giant tumor that seemed to be arising from a bladder diverticulum, with a mass effect and hydronephrosis. He later underwent operative intervention. Conclusions: Intradiverticular bladder tumors may present a challenge to the treating physician in an atypical presentation; thus requiring a high index of suspicion and knowledge of tumor pathophysiology. As illustrated in our case, CT with its wide availability and multiplanar imaging capabilities offers a useful means for diagnosis, disease staging, operative planning, and follow-up. PMID:28246375

  3. Echocardiographic features of subpulmonic obstruction in dextro-transposition of the great vessels.

    PubMed

    Nanda, N C; Gramiak, R; Manning, J A; Lipchik, E O

    1975-03-01

    Eleven patients with dextro-transposition of the great vessels (TGV) and subpulmonic (left ventriclar outflow) obstruction documented by cardiac catheterization and angiography were studied by echocardiography. Echocardiographic features were which characterized the outflow obstruction included a) prolonged diastolic apposition of the mitral valve with the ventricular septum (10 patients), b) smaller width of the pulmonary artery as compared to the aortic root (10 cases), and c) narrowing of the subpulmonic area demonstrated by beam anglation studies through the planes of the mitral valve and the pulmonary artery (five cases). In addition, four patients showed abnormal systolic anterior movements (SAMs) of the anterior mitral leaflet resembling those observed in idiopathic hypertrophic subaortic stenosis. The SAM'S WERE LARGE IN THREE PATIENTS AND MAY HAVE ACCENTUATED THE OUTFLOW OBSTRUCTION. Additional evidence for this was provided by the movement of the pulmonary valve towards closure with the onset of the mitral SAM'S. These features were uncommon or absent in a comparison group of 17 patients with TGV and no outflow obstruction. Echocardiography appears to be useful in the diagnosis of subpulmonic muscular obstruction in TGV. Demonstration of definite mitral SAM'S IN SOME PATIENTS SUGGEST THE PRESSENCE OF ASSOCIATED FUNCTIONAL OBSTRUCTION OF THE TYPE SEEN IN IDIOPATHIC HYPERTROPHIC SUBAORTIC STENOSIS.

  4. Adenocarcinoma of the urinary bladder.

    PubMed

    Dadhania, Vipulkumar; Czerniak, Bogdan; Guo, Charles C

    2015-01-01

    Adenocarcinoma is an uncommon malignancy in the urinary bladder which may arise primarily in the bladder as well as secondarily from a number of other organs. Our aim is to provide updated information on primary and secondary bladder adenocarcinomas, with focus on pathologic features, differential diagnosis, and clinical relevance. Primary bladder adenocarcinoma exhibits several different growth patterns, including enteric, mucinous, signet-ring cell, not otherwise specified, and mixed patterns. Urachal adenocarcinoma demonstrates similar histologic features but it can be distinguished from bladder adenocarcinoma on careful pathologic examination. Secondary bladder adenocarcinomas may arise from the colorectum, prostate, endometrium, cervix and other sites. Immunohistochemical study is valuable in identifying the origin of secondary adenocarcinomas. Noninvasive neoplastic glandular lesions, adenocarcinoma in situ and villous adenoma, are frequently associated with bladder adenocarcinoma. It is also important to differentiate bladder adenocarcinoma from a number of nonneoplastic lesions in the bladder. Primary bladder adenocarcinoma has a poor prognosis largely because it is usually diagnosed at an advanced stage. Urachal adenocarcinoma shares similar histologic features with bladder adenocarcinoma, but it has a more favorable prognosis than bladder adenocarcinoma, partly due to the relative young age of patients with urachal adenocarcinoma.

  5. Adenocarcinoma of the urinary bladder

    PubMed Central

    Dadhania, Vipulkumar; Czerniak, Bogdan; Guo, Charles C

    2015-01-01

    Adenocarcinoma is an uncommon malignancy in the urinary bladder which may arise primarily in the bladder as well as secondarily from a number of other organs. Our aim is to provide updated information on primary and secondary bladder adenocarcinomas, with focus on pathologic features, differential diagnosis, and clinical relevance. Primary bladder adenocarcinoma exhibits several different growth patterns, including enteric, mucinous, signet-ring cell, not otherwise specified, and mixed patterns. Urachal adenocarcinoma demonstrates similar histologic features but it can be distinguished from bladder adenocarcinoma on careful pathologic examination. Secondary bladder adenocarcinomas may arise from the colorectum, prostate, endometrium, cervix and other sites. Immunohistochemical study is valuable in identifying the origin of secondary adenocarcinomas. Noninvasive neoplastic glandular lesions, adenocarcinoma in situ and villous adenoma, are frequently associated with bladder adenocarcinoma. It is also important to differentiate bladder adenocarcinoma from a number of nonneoplastic lesions in the bladder. Primary bladder adenocarcinoma has a poor prognosis largely because it is usually diagnosed at an advanced stage. Urachal adenocarcinoma shares similar histologic features with bladder adenocarcinoma, but it has a more favorable prognosis than bladder adenocarcinoma, partly due to the relative young age of patients with urachal adenocarcinoma. PMID:26309895

  6. Unconventional aqueous humor outflow: A review.

    PubMed

    Johnson, Mark; McLaren, Jay W; Overby, Darryl R

    2017-05-01

    Aqueous humor flows out of the eye primarily through the conventional outflow pathway that includes the trabecular meshwork and Schlemm's canal. However, a fraction of aqueous humor passes through an alternative or 'unconventional' route that includes the ciliary muscle, supraciliary and suprachoroidal spaces. From there, unconventional outflow may drain through two pathways: a uveoscleral pathway where aqueous drains across the sclera to be resorbed by orbital vessels, and a uveovortex pathway where aqueous humor enters the choroid to drain through the vortex veins. We review the anatomy, physiology and pharmacology of these pathways. We also discuss methods to determine unconventional outflow rate, including direct techniques that use radioactive or fluorescent tracers recovered from tissues in the unconventional pathway and indirect methods that estimate unconventional outflow based on total outflow over a range of pressures. Indirect methods are subject to a number of assumptions and generally give poor agreement with tracer measurements. We review the variety of animal models that have been used to study conventional and unconventional outflow. The mouse appears to be a promising model because it captures several aspects of conventional and unconventional outflow dynamics common to humans, although questions remain regarding the magnitude of unconventional outflow in mice. Finally, we review future directions. There is a clear need to develop improved methods for measuring unconventional outflow in both animals and humans. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. 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.

  8. 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.

  9. Treatment of Bladder Dysfunction Using Stem Cell or Tissue Engineering Technique

    PubMed Central

    Kim, Jae Heon; Lee, Hong Jun

    2014-01-01

    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. PMID:24741410

  10. Outflows in Sodium Excess Objects

    NASA Astrophysics Data System (ADS)

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

    2015-08-01

    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.

  11. 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.

  12. Differential Canalograms Detect Outflow Changes from Trabecular Micro-Bypass Stents and Ab Interno Trabeculectomy

    PubMed Central

    Parikh, Hardik A.; Loewen, Ralitsa T.; Roy, Pritha; Schuman, Joel S.; Lathrop, Kira L.; Loewen, Nils A.

    2016-01-01

    Recently introduced microincisional glaucoma surgeries that enhance conventional outflow offer a favorable risk profile over traditional surgeries, but can be unpredictable. Two paramount challenges are the lack of an adequate training model for angle surgeries and the absence of an intraoperative quantification of surgical success. To address both, we developed an ex vivo training system and a differential, quantitative canalography method that uses slope-adjusted fluorescence intensities of two different chromophores to avoid quenching. We assessed outflow enhancement by trabecular micro-bypass (TMB) implantation or by ab interno trabeculectomy (AIT). In this porcine model, TMB resulted in an insignificant (p > 0.05) outflow increase of 13 ± 5%, 14 ± 8%, 9 ± 3%, and 24 ± 9% in the inferonasal, superonasal, superotemporal, and inferotemporal quadrant, respectively. AIT caused a 100 ± 50% (p = 0.002), 75 ± 28% (p = 0.002), 19 ± 8%, and 40 ± 21% increase in those quadrants. The direct gonioscopy and tactile feedback provided a surgical experience that was very similar to that in human patients. Despite the more narrow and discontinuous circumferential drainage elements in the pig with potential for underperformance or partial stent obstruction, unequivocal patterns of focal outflow enhancement by TMB were seen in this training model. AIT achieved extensive access to outflow pathways beyond the surgical site itself. PMID:27811973

  13. 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

  14. Urinary bladder xanthomatous cystitis

    PubMed Central

    Shah, Shrenik J.; Ajitsaria, Vineet; Singh, Vineet

    2017-01-01

    Xanthoma cystitis of urinary bladder is a rare entity and may present as an intravesical mass. A 38-year-old female presented with abdominal pain and imaging was done which was suggestive of a malignant mass with surrounding tissue infiltration. Partial cystectomy was performed, and histological examination of the mass showed xanthomatous cystitis. PMID:28197037

  15. 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.

  16. 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.

  17. Star formation inside a galactic outflow.

    PubMed

    Maiolino, R; Russell, H R; Fabian, A C; Carniani, S; Gallagher, R; Cazzoli, S; Arribas, S; Belfiore, F; Bellocchi, E; Colina, L; Cresci, G; Ishibashi, W; Marconi, A; Mannucci, F; Oliva, E; Sturm, E

    2017-04-13

    Recent observations have revealed massive galactic molecular outflows that may have the physical conditions (high gas densities) required to form stars. Indeed, several recent models predict that such massive outflows may ignite star formation within the outflow itself. This star-formation mode, in which stars form with high radial velocities, could contribute to the morphological evolution of galaxies, to the evolution in size and velocity dispersion of the spheroidal component of galaxies, and would contribute to the population of high-velocity stars, which could even escape the galaxy. Such star formation could provide in situ chemical enrichment of the circumgalactic and intergalactic medium (through supernova explosions of young stars on large orbits), and some models also predict it to contribute substantially to the star-formation rate observed in distant galaxies. Although there exists observational evidence for star formation triggered by outflows or jets into their host galaxy, as a consequence of gas compression, evidence for star formation occurring within galactic outflows is still missing. Here we report spectroscopic observations that unambiguously reveal star formation occurring in a galactic outflow at a redshift of 0.0448. The inferred star-formation rate in the outflow is larger than 15 solar masses per year. Star formation may also be occurring in other galactic outflows, but may have been missed by previous observations owing to the lack of adequate diagnostics.

  18. A Multiparous Woman with Lately Diagnosed Multilevel Left Ventricular Obstruction.

    PubMed

    Rahman, Muhammad Nasir; Gul, Ibrahim; Nabi, Amjad

    2017-05-01

    A 56-year hypertensive, multiparous woman presented to the cardiology unit with Canadian Cardiovascular Society (CCS) class-III angina and worsening dyspnea for the past few weeks. Her clinical examination showed high blood pressure and mid-systolic crescendo-decrescendo murmur radiating to carotids. However, there was no radio-femoral delay or significant blood pressure difference between her arms. Her transthoracic echocardiography (TTE) revealed moderate aortic stenosis (AS) and mid cavity left ventricular outflow (LVO) obstruction. Left heart catheterization (LHC) showed coarctation of aorta with extensive collaterals, mid cavity LVO obstruction, and moderate AS. Thus, she was diagnosed as a case of multi-level LVO obstruction including mid cavity LVO obstruction AS and coarctation of aorta. She underwent stenting of aortic coarctation as the initial step of graded approach to her disease, and is doing well.

  19. Assessment of right ventricular outflow tract in children by two-dimensional echocardiography using a new subcostal view. Angiocardiographic and morphologic correlative study.

    PubMed

    Isaaz, K; Cloez, J L; Danchin, N; Marçon, F; Worms, A M; Pernot, C

    1985-09-15

    Evaluation of the right ventricular (RV) outflow tract in congenital heart disease is extremely important for surgical management. Therefore, the value of 2-dimensional echocardiography (2-D echo) to assess the RV outflow tract was studied using a new approach: the subcostal elongated right oblique view. Twenty normal children and 49 children with congenital heart disease, aged 1 day to 11 years, were studied. Significant pulmonary infundibular obstruction was present in 22 patients with conotruncal malformations. To obtain the subcostal elongated right oblique view from the short-axis view at the aortic valve level, the transducer was slightly rotated clockwise with an anterior angulation of about 30 degrees so that the ascending aorta was seen in its long axis, providing an image similar to that obtained by a right ventriculogram in the elongated right anterior oblique view. The deviation of infundibular septum was appreciated by measurement of the angle alpha, defined by the long axis of the infundibular septum and the plane of aortic cusps. This view could be obtained in 64 patients (92%). In correlation with angiographic or anatomic data, the subcostal elongated right oblique view permitted recognition of several types of RV outflow tract: type I--normally formed RV outflow tract; type II--disorganized RV outflow tract with obstruction (alpha less than 90 degrees); type III and IV--disorganized RV outflow tract with obstruction (alpha greater than 90 degrees). This view could visualize the crista supraventricularis in type I, but also the anatomic components of RV outflow tract that may contribute to obstruction in the other types: infundibular septum, septoparietal trabeculations and trabecula septomarginalis.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. OUTFLOW-CORE INTERACTION IN BARNARD 1

    SciTech Connect

    Hiramatsu, Masaaki; Hirano, Naomi; Takakuwa, Shigehisa

    2010-04-01

    In order to study how outflows from protostars influence the physical and chemical conditions of the parent molecular cloud, we have observed the Barnard 1 (B1) main core, which harbors four Class 0 and three Class I sources, in the CO (J = 1 - 0), CH{sub 3}OH (J{sub K} = 2{sub K} - 1{sub K}), and the SiO (J = 1 - 0) lines using the Nobeyama 45 m telescope. We have identified three CO outflows in this region: one is an elongated ({approx}0.3 pc) bipolar outflow from a Class 0 protostar B1-c in the submillimeter clump SMM 2, another is a rather compact ({approx}0.1 pc) outflow from a Class I protostar B1 IRS in the clump SMM 6, and the other is an extended outflow from a Class I protostar in SMM 11. In the western lobe of the SMM 2 outflow, both the SiO and CH{sub 3}OH lines show broad redshifted wings with the terminal velocities of 25 km s{sup -1} and 13 km s{sup -1}, respectively. It is likely that the shocks caused by the interaction between the outflow and ambient gas enhance the abundance of SiO and CH{sub 3}OH in the gas phase. The total energy input rate by the outflows (1.1 x 10{sup -3} L{sub sun}) is smaller than the energy-loss rate (8.5 x 10{sup -3} L{sub sun}) through the turbulence decay in the B1 main core, which suggests that the outflows cannot sustain the turbulence in this region. Since the outflows are energetic enough to compensate the dissipating turbulence energy in the neighboring, more evolved star-forming region NGC 1333, we suggest that the turbulence energy balance depends on the evolutionary state of the star formation in molecular clouds.

  1. 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

  2. Alterations in the contractile phenotype of the bladder: lessons for understanding physiological and pathological remodelling of smooth muscle

    PubMed Central

    Zderic, Stephen A; Chacko, Samuel

    2012-01-01

    Abstract The contractile properties of the urinary bladder are changed by the conditions of normal development and partial bladder outlet obstruction. This change in the contractile phenotype is accompanied by changes in the regulatory cascades and filaments that regulate contractility. This review focuses on such changes during the course of normal development and in response to obstruction. Our goal is to discuss the experimental evidence that has accumulated from work in animal models and correlate these findings with the human voiding phenotype. PMID:21707917

  3. Inguinal Herniation Containing Bladder, Causing Contralateral Allograft Hydroureteronephrosis-A Case Report and Literature Review.

    PubMed

    du Toit, T; Kaestner, L; Muller, E; Kahn, D

    2017-02-01

    We report the first documented case of an inguinal hernia containing bladder, resulting in contralateral allograft hydroureteronephrosis. A 39-year-old male patient presented with allograft dysfunction, a contralateral inguinoscrotal hernia, and marked hydroureteronephrosis on ultrasound (US). Percutaneous nephrostogram and a retrograde cystogram suggested bladder herniation with incorporation of the contralateral ureteroneocystostomy into the hernia. Paraperitoneal bladder herniation was confirmed at surgery and hernioplasty was performed. Six-week follow-up revealed normal renal function with no sign of hernia recurrence. Despite occurring rarely, transplant ureter or bladder herniation should be considered in the differential diagnosis of hydroureteronephrosis. This case illustrates that the contralateral position of hernia to allograft does not necessarily preclude the hernia as the source of ureteric obstruction.

  4. The relationship between pressure flow studies and ultrasound-estimated bladder wall mass.

    PubMed

    Kelly, Christopher E

    2005-01-01

    The basic evaluation of suspected voiding dysfunction involves fundamental objective tools such as the pressure-flow study. Although accurate, the several drawbacks to this invasive study of bladder outlet obstruction (BOO) are discussed and evaluated. Other non-invasive and/or minimally invasive ways of diagnosing BOO continue to be the subject of investigation. The ultrasound-estimated bladder wall thickness and bladder wall mass indices are 2 parameters that may be useful for screening and diagnosing BOO. Preliminary results are presented from the prospective clinical trial comparing the diagnosing capabilities and results obtained with pressure-flow studies (the historic gold standard for BOO diagnosing) with that of ultrasound-estimated bladder weight.

  5. Surgical Myectomy after Failed Ablation for Hypertrophic Obstructive Cardiomyopathy

    PubMed Central

    Bougioukas, Ioannis; Hoppe, Uta; Danner, Bernhard; Schoendube, Friedrich A.

    2016-01-01

    Background Hypertrophic cardiomyopathy is a genetic disease of the myocardial sarcolemma characterized by left ventricular hypertrophy. When obstruction to the left ventricular outflow tract is present and symptoms are refractory to medication, surgical myectomy or alcohol septal ablation is indicated. Case Description We report a case of a patient presented for myectomy due to recurrence only 1 year after alcohol ablation. Interesting findings were a firm subaortic membrane and a direct insertion of the papillary muscle into the mitral valve. Conclusion After myectomy and extensive papillary muscle mobilization, a significant relief of obstruction was achieved. PMID:28018818

  6. Delayed complication of pelvic lymphocele: Ileal conduit obstruction.

    PubMed

    Bankar, Sanket S; Bakshi, Ganesh K; Prakash, Gagan; Sable, Nilesh P

    2015-01-01

    Radical cystectomy is the standard treatment for muscle invasive bladder cancer. Lymphocele is a common sequalae of pelvic lymphadenectomy. We report an unusual presentation of pelvic lymphocele developing after radical cystectomy reconstructed with an ileal conduit where the patient developed obstruction of the ileal conduit loop due to external pressure of the lymphocele. Catheter drainage of the conduit relieved the symptoms and a computerized tomography scan showed a large lymphocele causing acute angulation and resultant obstruction of the ileal conduit. The patient was treated with percutaneous drainage of the lymphocele and remains symptom-free on follow-up at 1 year.

  7. Delayed complication of pelvic lymphocele: Ileal conduit obstruction

    PubMed Central

    Bankar, Sanket S.; Bakshi, Ganesh K.; Prakash, Gagan; Sable, Nilesh P.

    2015-01-01

    Radical cystectomy is the standard treatment for muscle invasive bladder cancer. Lymphocele is a common sequalae of pelvic lymphadenectomy. We report an unusual presentation of pelvic lymphocele developing after radical cystectomy reconstructed with an ileal conduit where the patient developed obstruction of the ileal conduit loop due to external pressure of the lymphocele. Catheter drainage of the conduit relieved the symptoms and a computerized tomography scan showed a large lymphocele causing acute angulation and resultant obstruction of the ileal conduit. The patient was treated with percutaneous drainage of the lymphocele and remains symptom-free on follow-up at 1 year. PMID:26166973

  8. Massive obstructive urolithiasis in a bull used for artificial insemination.

    PubMed

    Ogaa, J S; Agumbah, G J; Patel, J H; Kiere, S; Mwangi, J L

    A seven-year-old Jersey bull used for artificial insemination showed clinical signs of obstructive urolithiasis. This was confirmed by catheterisation and subsequent urethrotomy over the site of obstruction distal to the sigmoid flexure. Although urine flow was elicited after removal of the calculi, this was only temporary and the animal had to be killed 24 hours later. On post mortem examination about 2 kg of round, smooth, pearl-like calculi were found in the urinary bladder and the urethra of the sigmoid flexure was studded with similar calculi. It was concluded that urethrotomy at the sigmoid flexure or penectomy post scrotally would not have alleviated this condition.

  9. 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

  10. Innovation in Bladder Cancer Immunotherapy.

    PubMed

    Grossman, H Barton; Lamm, Donald L; Kamat, Ashish M; Keefe, Stephen; Taylor, John A; Ingersoll, Molly A

    2016-10-01

    Bladder cancer is understudied despite its high prevalence and its remarkable response to immunotherapy. Indeed, funding for studies to explore mechanisms of tumor immunity and novel new therapeutics is disproportionately lower for bladder cancer in comparison with malignancies of the breast, prostate, or lung. However, the recent successes of checkpoint blockade therapy suggest that new therapeutic strategies are on the horizon for bladder cancer. Here, we give a perspective into the evolution of bladder cancer therapy, focusing on strategies to treat high-risk nonmuscle invasive disease, followed by a discussion of recent advances in the treatment of muscle invasive bladder cancer and their potential applicability to lower stage disease. Finally, we explore immunotherapeutic strategies, which have been demonstrated to be successful in the treatment of other malignancies, for their potential to treat and cure patients with nonmuscle and muscle invasive bladder cancer.

  11. 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.

  12. Bladder neck resection with preservation of antegrade ejaculation: Basir technique.

    PubMed

    Abdel-Basir Sayed, Mohamed

    2003-03-01

    To evaluate a new method of bladder neck resection and to determine if antegrade ejaculation is preserved thereafter. Two groups of patients were treated for their bladder neck obstruction. Group A, composed of 20 patients, was treated by bladder neck resection with preservation of more than 1 cm proximal to the verumontanum. Group B, also consisting of 20 patients, was treated by the old technique. Patients were evaluated before and after resection by semen volume, sperm count, symptoms, and urodynamic testing. In group A, antegrade ejaculation was maintained in 17 of the 20 patients (85%), while in 2 patients, only a small amount of semen was ejaculated and in 1 patient, complete retrograde ejaculation was reported. In group B, only 4 patients (20%) preserved antegrade ejaculation, and retrograde ejaculation occurred in 16 patients (80%). With preservation of >1 cm of the supramontanal part of the urethra during bladder neck resection, we could avoid the complication of retrograde ejaculation in those young patients who wish to preserve fertility.

  13. Contemporary Management of Bladder Cancer

    PubMed Central

    Bell, David; Fradet, Yves

    1991-01-01

    Bladder cancer is currently the fifth most common cancer in Western society, and its incidence appears to be increasing. Important advances have recently occurred in both diagnostic and therapeutic approaches to bladder neoplasms. Presentation is not unique, and physician awareness is important to identify patients who are at risk for bladder neoplasia and consequently require further investigation. A diagnostic approach and contemporary management are discussed. ImagesFigure 1Figure 4 PMID:21229043

  14. Physiological and pathophysiological implications of micromotion activity in urinary bladder function.

    PubMed

    Vahabi, B; Drake, M J

    2015-02-01

    'Micromotions' is a term signifying the presence of localized microcontractions and microelongations, alongside non-motile areas. The motile areas tend to shift over the bladder surface with time, and the intravesical pressure reflects moment-by-moment summation of the interplay between net contractile force generated by micromotions and general bladder tone. Functionally, the bladder structure may comprise modules with variable linkage, which supports presence of localized micromotions (no functional linkage between modules), propagating contractions (where emergence of linkage allows sequential activation) and the shifting of micromotions over time. Detrusor muscle, interstitial cells and intramural innervation have properties potentially relevant for initiating, coordinating and modulating micromotions. Conceptually, such activity could facilitate the generation of afferent activity (filling state reporting) in the absence of intravesical pressure change and the ability to transition to voiding at any bladder volume. This autonomous activity is an intrinsic property, seen in various experimental contexts including the clinical setting of human (female) overactive bladder. 'Disinhibited autonomy' may explain the obvious micromotions in isolated bladders and perhaps contribute clinically in neurological disease causing detrusor overactivity. Furthermore, any process that could increase the initiation or propagation of microcontractions might be anticipated to have a functional effect, increasing the likelihood of urinary urgency and detrusor overactivity respectively. Thus, models of bladder outlet obstruction, neurological trauma and ageing provide a useful framework for detecting cellular changes in smooth muscle, interstitial cells and innervation, and the consequent effects on micromotions.

  15. Effects of electroacupuncture combined with bladder training on the bladder function of patients with neurogenic bladder after spinal cord injury

    PubMed Central

    Xia, Li-Ping; Fan, Fan; Tang, Ai-Ling; Ye, Wen-Qin

    2014-01-01

    Neurogenic bladder is a common complication of spinal cord injury and results in urinary bladder dysfunction through lost control of micturition, or urination. Although several treatment options exist, the efficacies of many of these treatments are unknown. In particular, electroacupuncture and bladder training have had some success as individual treatments. The aim of this study was to explore effects of electroacupuncture combined with bladder training on bladder function of patients with neurogenic bladder after spinal cord injury (SCI) above the sacral segment. Forty-two patients with neurogenic bladder after SCI were evenly divided into two groups (n=21) and given only bladder function training (control group) or electroacupuncture combined with bladder function training (treatment group). Urodynamic changes, IPSS score, and therapeutic efficacy were compared between groups pre- and post-treatment. After either treatment, patients had higher bladder volume and bladder compliance, but lower residual urine volume, bladder pressure, rectal pressure, and detrusor pressure, compared to pre-treatment (P<0.05). Compared to controls, treatment group patients had significantly increased bladder volume and bladder compliance, but significantly decreased residual urine volume, bladder pressure, rectal pressure, and detrusor pressure (P<0.05). Treatment group patients had lower IPSS scores post-treatment (P<0.05) and better therapeutic efficacy (P<0.05) than control group patients. Altogether, our results suggest that electroacupuncture combined with bladder function training can clinically improve bladder function of patients with neurogenic bladder after SCI above the sacral segment. PMID:24995093

  16. [Diet in bladder cancer ethiopathogenesis].

    PubMed

    Radosavljević, V; Ilić, M; Janković, S; Djokić, M

    2005-01-01

    The aim of this paper is to show influence of different foods on bladder cancer appearance, as well as possible consequent ways of prevention. Consuption of food rich in animal fat and cholesterol, fried foods, especially several times used cookin oil for frying, processed meat with additives (nitrates, nitrites, azo-colourrs) can influence bladder cancer occurrence. Regularly, continous consumption of fermented milk products, which contains come types of milky--acids bacterias, is considered as protective factor in developing bladder cancer. Reports that fruit and vegetable are protective food items are pretty consistent. Data about mineral intake and bladder cancer are obscure.

  17. 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.

  18. [A rare cause of urinary obstruction: urogenital tuberculosis].

    PubMed

    Fekak, H; Rabii, R; Moufid, K; Joual, A; Debbagh, A; Bennani, A; el Mrini, M; Benjelloun, S

    2003-04-01

    The authors reported a rare cause of urogenital tuberculosis complicated by an obstructive acute renal failure in 44 years old man with solitary anatomic kidney. The authors insisted of using the upper urinary tract opacification by percutaneous nephrostomy for diagnosis, the urogenital tuberculosis with this exploration, we can suspected the tuberculosis by abnormalities of the radiologic imagine, and confirmed the koch bacilli urinary into urinary tract. The upper chance of positives of finding koch bacilli in higher than urinary bladder.

  19. Pyloric obstruction secondary to epicardial pacemaker implantation: a case report.

    PubMed

    Bedoya Nader, G; Kellihan, H B; Bjorling, D E; McAnulty, J

    2017-02-01

    A 10-year old Lhasa Apso dog was presented for an acute history of exercise intolerance and hind limb weakness. High grade second degree atrioventricular block with an atrial rate of 200 beats per minute, ventricular rate of 40 beats per minute and an intermittent ventricular escape rhythm, was diagnosed on electrocardiograph. A transdiaphragmatic, unipolar, epicardial pacemaker was implanted without immediate surgical complications. Severe vomiting was noted 12 h post-operatively. Abdominal ultrasound and a barium study supported a diagnosis of pyloric outflow obstruction and exploratory abdominal surgery was performed. The pyloric outflow tract appeared normal and no other causes of an outflow obstruction were identified. The epicardial generator was repositioned from the right to the left abdominal wall. Pyloric cell pacing was presumed to be the cause for the pyloric obstruction and severe vomiting, and this was thought to be due to close proximity of the pacemaker generator to the pylorus situated in the right abdominal wall. Repositioning of the pulse generator to the left abdominal wall resulted in resolution of vomiting. Copyright © 2016 Elsevier B.V. All rights reserved.

  20. Hemolytic anemia in a patient with hypertrophic obstructive cardiomyopathy.

    PubMed

    Kubo, Toru; Kitaoka, Hiroaki; Terauchi, Yasunobu; Tamura, Shinjiro; Okawa, Makoto; Yamasaki, Naohito; Yabe, Toshikazu; Doi, Yoshinori L

    2010-01-01

    A 66-year-old woman was referred for further evaluation and treatment of normocytic and normochromic anemia with hemoglobin level of 8.6 g/dL. A peripheral blood smear showed fragmented erythrocytes. The patient was then referred to the department of cardiology because of systolic murmur, ECG abnormality, and red cell fragmentation. Transthoracic echocardiography revealed hypertrophic cardiomyopathy with particularly increased interventricular septal thickness of 24 mm and a hyperkinetic wall motion, resulting in marked obstruction to left ventricular outflow tract (pressure gradient of 200 mmHg). Mitral regurgitation due to systolic anterior motion of the mitral valve leaflets was also seen. The cause of anemia was thought to be mechanical intravascular hemolysis due to left ventricular outflow tract obstruction and mitral regurgitation. She was treated with atenolol and the class Ia antiarrhythmic drug cibenzoline to relieve the outflow tract obstruction, and the pressure gradient was reduced to 70 mmHg. After 3 months of treatment, her hemoglobin level had increased to 11.4 g/dL without additional treatment for anemia.

  1. 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.

  2. 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 ...

  3. Obstructive Sleep Apnea

    MedlinePlus

    ... sleep apnea increase blood pressure and strain the cardiovascular system. Many people with obstructive sleep apnea develop high blood pressure (hypertension), which can increase the risk of heart disease. The more severe the obstructive sleep apnea, the ...

  4. 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 ...

  5. Evidence for bladder urothelial pathophysiology in functional bladder disorders.

    PubMed

    Keay, Susan K; Birder, Lori A; Chai, Toby C

    2014-01-01

    Understanding of the role of urothelium in regulating bladder function is continuing to evolve. While the urothelium is thought to function primarily as a barrier for preventing injurious substances and microorganisms from gaining access to bladder stroma and upper urinary tract, studies indicate it may also function in cell signaling events relating to voiding function. This review highlights urothelial abnormalities in bladder pain syndrome/interstitial cystitis (BPS/IC), feline interstitial cystitis (FIC), and nonneurogenic idiopathic overactive bladder (OAB). These bladder conditions are typified by lower urinary tract symptoms including urinary frequency, urgency, urgency incontinence, nocturia, and bladder discomfort or pain. Urothelial tissues and cells from affected clinical subjects and asymptomatic controls have been compared for expression of proteins and mRNA. Animal models have also been used to probe urothelial responses to injuries of the urothelium, urethra, or central nervous system, and transgenic techniques are being used to test specific urothelial abnormalities on bladder function. BPS/IC, FIC, and OAB appear to share some common pathophysiology including increased purinergic, TRPV1, and muscarinic signaling, increased urothelial permeability, and aberrant urothelial differentiation. One challenge is to determine which of several abnormally regulated signaling pathways is most important for mediating bladder dysfunction in these syndromes, with a goal of treating these conditions by targeting specific pathophysiology.

  6. Impact Wire Dislodges Obstructions

    NASA Technical Reports Server (NTRS)

    Ricklefs, Steven K.; Anders, Jeffrey E.

    1990-01-01

    Snakelike tool loosens trapped debris obstructing narrow passages in normally inaccessible locations. Flexible tool threaded into obstructed channel, much like common plumbing snake. Wire fed along inner tube of tool until tip reaches obstruction. Delivers impact from impact tool to obstruction. Designed for use in narrow, intricate coolant channels of rocket engine. Lends itself readily to modification for use in engine blocks, heat exchangers, general plumbing, and like.

  7. Magnetosphere sawtooth oscillations induced by ionospheric outflow.

    PubMed

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

    2011-06-03

    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.

  8. Accretion, Outflows, and Winds of Magnetized Stars

    NASA Astrophysics Data System (ADS)

    Romanova, Marina M.; Owocki, Stanley P.

    2015-10-01

    Many types of stars have strong magnetic fields that can dynamically influence the flow of circumstellar matter. In stars with accretion disks, the stellar magnetic field can truncate the inner disk and determine the paths that matter can take to flow onto the star. These paths are different in stars with different magnetospheres and periods of rotation. External field lines of the magnetosphere may inflate and produce favorable conditions for outflows from the disk-magnetosphere boundary. Outflows can be particularly strong in the propeller regime, wherein a star rotates more rapidly than the inner disk. Outflows may also form at the disk-magnetosphere boundary of slowly rotating stars, if the magnetosphere is compressed by the accreting matter. In isolated, strongly magnetized stars, the magnetic field can influence formation and/or propagation of stellar wind outflows. Winds from low-mass, solar-type stars may be either thermally or magnetically driven, while winds from massive, luminous O and B type stars are radiatively driven. In all of these cases, the magnetic field influences matter flow from the stars and determines many observational properties. In this chapter we review recent studies of accretion, outflows, and winds of magnetized stars with a focus on three main topics: (1) accretion onto magnetized stars; (2) outflows from the disk-magnetosphere boundary; and (3) winds from isolated massive magnetized stars. We show results obtained from global magnetohydrodynamic simulations and, in a number of cases compare global simulations with observations.

  9. Quantifying Supernovae-driven Multiphase Galactic Outflows

    NASA Astrophysics Data System (ADS)

    Li, Miao; Bryan, Greg L.; Ostriker, Jeremiah P.

    2017-06-01

    Galactic outflows are observed everywhere in star-forming disk galaxies and are critical for galaxy formation. Supernovae (SNe) play the key role in driving the outflows, but there is no consensus as to how much energy, mass, and metal they can launch out of the disk. We perform 3D, high-resolution hydrodynamic simulations to study SNe-driven outflows from stratified media. Assuming the SN rate scales with gas surface density Σgas as in the Kennicutt-Schmidt relation, we find that the mass loading factor, η m, defined as the mass outflow flux divided by the star formation surface density, decreases with increasing Σgas as {η }{{m}}\\propto {{{Σ }}}{gas}-0.61. Approximately Σgas ≲ 50 M ⊙ pc-2 marks when η m ≳ 1. About 10%-50% of the energy and 40%-80% of the metals produced by SNe end up in the outflows. The tenuous hot phase (T > 3 × 105 K), which fills 60%-80% of the volume at the midplane, carries the majority of the energy and metals in the outflows. We discuss how various physical processes, including the vertical distribution of SNe, photoelectric heating, external gravitational field, and SN rate, affect the loading efficiencies. The relative scale height of gas and SNe is a very important factor in determining the loading efficiencies.

  10. Immunotherapy for bladder cancer

    PubMed Central

    Fuge, Oliver; Vasdev, Nikhil; Allchorne, Paula; Green, James SA

    2015-01-01

    It is nearly 40 years since Bacillus Calmette–Guérin (BCG) was first used as an immunotherapy to treat superficial bladder cancer. Despite its limitations, to date it has not been surpassed by any other treatment. As a better understanding of its mechanism of action and the clinical response to it have evolved, some of the questions around optimal dosing and treatment protocols have been answered. However, its potential for toxicity and failure to produce the desired clinical effect in a significant cohort of patients presents an ongoing challenge to clinicians and researchers alike. This review summarizes the evidence behind the established mechanism of action of BCG in bladder cancer, highlighting the extensive array of immune molecules that have been implicated in its action. The clinical aspects of BCG are discussed, including its role in reducing recurrence and progression, the optimal treatment regime, toxicity and, in light of new evidence, whether or not there is a superior BCG strain. The problems of toxicity and non-responders to BCG have led to development of new techniques aimed at addressing these pitfalls. The progress made in the laboratory has led to the identification of novel targets for the development of new immunotherapies. This includes the potential augmentation of BCG with various immune factors through to techniques avoiding the use of BCG altogether; for example, using interferon-activated mononuclear cells, BCG cell wall, or BCG cell wall skeleton. The potential role of gene, virus, or photodynamic therapy as an alternative to BCG is also reviewed. Recent interest in the immune check point system has led to the development of monoclonal antibodies against proteins involved in this pathway. Early findings suggest benefit in metastatic disease, although the role in superficial bladder cancer remains unclear. PMID:26000263

  11. 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.

  12. Active Galactic Nuclei Feedback and Galactic Outflows

    NASA Astrophysics Data System (ADS)

    Sun, Ai-Lei

    Feedback from active galactic nuclei (AGN) is thought to regulate the growth of supermassive black holes (SMBHs) and galaxies. The most direct evidence of AGN feedback is probably galactic outflows. This thesis addresses the link between SMBHs and their host galaxies from four different observational perspectives. First, I study the local correlation between black hole mass and the galactic halo potential (the MBH - Vc relation) based on Very Large Array (VLA) HI observations of galaxy rotation curves. Although there is a correlation, it is no tighter than the well-studied MBH - sigma* relation between the black hole mass and the potential of the galactic bulge, indicating that physical processes, such as feedback, could link the evolution of the black hole to the baryons in the bulge. In what follows, I thus search for galactic outflows as direct evidence of AGN feedback. Second, I use the Atacama Large Millimeter Array (ALMA) to observe a luminous obscured AGN that hosts an ionized galactic outflow and find a compact but massive molecular outflow that can potentially quench the star formation in 10. 6 years.The third study extends the sample of known ionized outflows with new Magellan long-slit observations of 12 luminous obscured AGN. I find that most luminous obscured AGN (Lbol > 1046 ergs s-1) host ionized outflows on 10 kpc scales, and the size of the outflow correlates strongly with the luminosity of the AGN. Lastly, to capitalize on the power of modern photometric surveys, I experiment with a new broadband imaging technique to study the morphology of AGN emission line regions and outflows. With images from the Sloan Digital Sky Survey (SDSS), this method successfully constructs images of the [OIII]lambda5007 emission line and reveals hundreds of extended emission-line systems. When applied to current and future surveys, such as the Large Synoptic Survey Telescope (LSST), this technique could open a new parameter space for the study of AGN outflows. In

  13. 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.

  14. Defining Causes for Overactive Bladder Symptoms in Women.

    PubMed

    Fan, Yu-Hua; Lin, Alex T L; Chen, Kuang-Kuo

    2012-05-01

    The aim of the present study was to determine the causes for overactive bladder (OAB) symptoms in women visiting a urological clinic. We prospectively recruited female patients with OAB symptoms between December 2008 and February 2010. All patients were interviewed for their detailed personal and medical history. All patients completed a 3-day frequency-volume chart. Symptom severity was evaluated using the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) questionnaires. All patients underwent either conventional pressure-flow urodynamic studies or video-urodynamic studies. On the basis of these evaluations, patients were assigned to one of the following categories: idiopathic OAB, stress urinary incontinence (SUI)-associated, neurogenic bladder, or bladder outlet obstruction (BOO). A total of 108 female patients were recruited into the study. The mean age of the patients was 63.75 ± 14.02 years (range: 23-89). Detrusor overactivity was demonstrated in 55 patients (51%). The differential diagnosis was idiopathic OAB in 51 women (47.2%), SUI-associated in 46 (42.6%), neurogenic bladder in 13 (12.0%) and BOO in 7 (6.5%). Our study suggests that the causes for OAB symptoms could be defined in half of the women visiting a urological clinic. Among them, SUI was the most common. Moreover, OAB symptoms in women might relate to BOO. Detailed history taking and sophisticated urodynamic studies are required for a substantial group of female patients with OAB symptoms to make the correct diagnosis and provide optimal therapy. © 2012 Blackwell Publishing Asia Pty Ltd.

  15. Proliposomal Intravesical Paclitaxel for Treatment of Low-Grade, Stage Ta, Non Muscle Invasive Bladder Cancer

    ClinicalTrials.gov

    2017-03-16

    Bladder Cancer Cell Transitional; Non-Muscle Invasive Bladder Cancer; Bladder Cancer; Urinary Bladder; Transitional Cell Carcinoma of the Bladder; Urinary Bladder Neoplasms; Urologic Neoplasms; Urogenital Neoplasms; Urinary Bladder Diseases; Urologic Diseases

  16. 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

  17. 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.

  18. Powerful Quasar Outflows at High Redshifts

    NASA Astrophysics Data System (ADS)

    Aljanahi, Sara; Robert Scott Barrows

    2017-01-01

    Powerful quasar outflows can be driven by radiation pressure or radio jets, and they are capable of effecting the evolution of their host galaxies, particularly at high-redshifts (z~2)) when the quasar density peaks. We present a multi-wavelength analysis of 131 quasar outflows at high-redshifts (0.8outflows, their impact on the host galaxies, and their environments. We find that a subsample of 32 are detected by FIRST with 21 of them showing evidence for extended radio emission that suggests the outflows may be driven by the mechanical energy of radio jets in up to one-third of the sample. For the remaining two thirds of the sample, radiation pressure from the accretion disk is likely the driving mechanism. For those sources, we use the spatial information from long-slit spectra to estimate the energy of the outflowing gas, finding that one hundredth of the quasar energy is coupled with the energy being emitted by the radiation pressure from the accretion disk. Three of the quasars are found in the Hubble Space Telescope archives, with two of them showing clear signs of galaxy interactions/mergers, and a fraction of 0.4 show evidence of interactions from SDSS imaging. These combined results suggests that galaxy interactions may be the triggers of enhanced accretion onto the nuclear supermassive black holes of this sample, with the corresponding enhanced radiation pressure driving the outflows. Furthermore, the high-redshift nature of this sample has pushed the systematic study of quasar outflows closer to the epoch in which quasar feedback is likely to have been important in galaxy evolution.

  19. [Drug therapy of bladder dysfunction].

    PubMed

    Caremel, R; Cornu, J-N; Kerdraon, J; Castel-Lacanal, E; Bastide, C; Bruyere, F; Guy, L; Karsenty, G

    2013-11-01

    To describe drugs targeting urinary bladder to treat bladder dysfunctions such as OAB, NDO and bladder pain syndrome. Pubmed search for efficacy, mode of action and side effects for each molecule. Additional data were searched from the French regulatory agencies web sites (HAS and ANSM). Anticholinergics antimuscarinics remain the first-line treatment option for both OAB and NDO. Beta-3 adrenergics emerges as a new therapeutic class for OAB. Post approval safety as well as association with other micturition cycle's drugs need to be evaluated. Phosphodiesterase 5 inhibitors are effective to treat BPH-related LUTS including storage symptoms. Botulinum toxin type A injections within the detrusor are effective and approved to treat NDO in MS and spinal cord injured patients voiding with clean intermittent catheterization. Evaluation of such approach to treat OAB is ongoing. Drug therapy for bladder pain syndrome has limited efficacy including pentosan polyphosphate despite it has a temporary autorisation. There is no drug treatment to restore or improve bladder contraction. Armamenterium to treat bladder dysfunction has recently increased. Three new therapeutic classes emerged. Careful post approval evaluation is mandatory and study of these drugs' combination is expected. Results should drive changes in bladder dysfunction treatment algorithms. Copyright © 2013. Published by Elsevier Masson SAS.

  20. 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

  1. Inguinal Herniation of the Urinary Bladder Presenting as Recurrent Urinary Retention

    PubMed Central

    Frenkel, Amit; Roy-Shapira, Aviel; Shelef, Ilan; Shaked, Gadi; Koyfman, Leonid; Borer, Abraham; Klein, Moti

    2015-01-01

    Herniation of the urinary bladder into the inguinal canal is an uncommon finding, observed in 0.5–4% of inguinal hernias (Curry (2000)). It is usually associated with other conditions that increase intra-abdominal pressure such as bladder neck obstruction due to prostatic hypertrophy. Consequently, in men, it is usually associated with some degree of urinary retention. We present a 42-year-old man in whom herniation of the urinary bladder was the cause of urinary retention, and not vice versa. The patient was on tumor necrosis factor alpha antagonist (TNFA) (Etanercept) for severe Ankylosing spondylitis. Initially, the urinary retention was thought to be a side effect of the medication, but after the drug was discontinued, urinary retention persisted. CT and MRI demonstrated huge herniation of the urinary bladder into the inguinal canal. Immediately after the hernia was repaired, bladder function was restored. TNF treatment was restarted, and no further urinary symptoms were observed in the next two years of follow-up. In this case, the primary illness and its treatment were distracting barriers to early diagnosis and treatment. In younger patients with a large hernia who develop unexpected urinary retention, herniation of the urinary bladder should be highly considered in the differential diagnosis. PMID:26075132

  2. 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.

  3. LVAD Outflow Graft Angle and Thrombosis Risk.

    PubMed

    Aliseda, Alberto; Chivukula, Venkat Keshav; Mcgah, Patrick; Prisco, Anthony R; Beckman, Jennifer A; Garcia, Guilherme J M; Mokadam, Nahush A; Mahr, Claudius

    This study quantifies thrombogenic potential (TP) of a wide range of left ventricular assist device (LVAD) outflow graft anastomosis angles through state-of-the-art techniques: 3D imaged-based patient-specific models created via virtual surgery and unsteady computational fluid dynamics with Lagrangian particle tracking. This study aims at clarifying the influence of a single parameter (outflow graft angle) on the thrombogenesis associated with flow patterns in the aortic root after LVAD implantation. This is an important and poorly-understood aspect of LVAD therapy, because several studies have shown strong inter and intrapatient thrombogenic variability and current LVAD implantation strategies do not incorporate outflow graft angle optimization. Accurate platelet-level investigation, enabled by statistical treatment of outliers in Lagrangian particle tracking, demonstrates a strong influence of outflow graft anastomoses angle on thrombogenicity (platelet residence times and activation state characterized by shear stress accumulation) with significantly reduced TP for acutely-angled anastomosed outflow grafts. The methodology presented in this study provides a device-neutral platform for conducting comprehensive thrombogenicity evaluation of LVAD surgical configurations, empowering optimal patient-focused surgical strategies for long-term treatment and care for advanced heart failure patients.

  4. Widening of Protostellar Outflows: An Infrared Outflow Survey in Low-luminosity Objects

    NASA Astrophysics Data System (ADS)

    Hsieh, Tien-Hao; Lai, Shih-Ping; Belloche, Arnaud

    2017-04-01

    We present an outflow survey toward 20 low-luminosity objects (LLOs), namely, protostars with an internal luminosity lower than 0.2 {L}⊙ . Although a number of studies have reported the properties of individual LLOs, the reasons for their low luminosity remain uncertain. To answer this question, we need to know the evolutionary status of LLOs. Protostellar outflows are found to widen as their parent cores evolve, and therefore the outflow opening angle could be used as an evolutionary indicator. The infrared scattered light escapes out through the outflow cavity and highlights the cavity wall, giving us the opportunity to measure the outflow opening angle. Using the Canada-France-Hawaii Telescope, we detected outflows toward eight LLOs out of 20 at Ks band, and based on archival Spitzer IRAC1 images, we added four outflow-driving sources from the remaining 12 sources. By fitting these images with radiative transfer models, we derive the outflow opening angles and inclination angles. To study the widening of outflow cavities, we compare our sample with the young stellar objects from Arce & Sargent and Velusamy et al. in a plot of opening angle versus bolometric temperature taken as an evolutionary indicator. Our LLO targets match well the trend of increasing opening angle with bolometric temperature reported by Arce & Sargent and are broadly consistent with that reported by Velusamy et al., suggesting that the opening angle could be a good evolutionary indicator for LLOs. Accordingly, we conclude that at least 40% of the outflow-driving LLOs in our sample are young Class 0 objects.

  5. Bladder Capacity is a Biomarker for a Bladder Centric versus Systemic Manifestation in Interstitial Cystitis/Bladder Pain Syndrome.

    PubMed

    Walker, Stephen J; Zambon, João; Andersson, Karl-Erik; Langefeld, Carl D; Matthews, Catherine A; Badlani, Gopal; Bowman, Heather; Evans, Robert J

    2017-02-12

    Interstitial cystitis/bladder pain syndrome presents a significant clinical challenge due to symptom heterogeneity and the myriad associated comorbid medical conditions. We recently reported that diminished bladder capacity may represent a specific interstitial cystitis/bladder pain syndrome subphenotype. The objective of this study was to investigate the relationship between anesthetic bladder capacity, and urological and nonurological clinical findings in a cohort of patients with interstitial cystitis/bladder pain syndrome who had undergone therapeutic urinary bladder hydrodistention. This is a retrospective chart review of prospectively collected data on women diagnosed with interstitial cystitis/bladder pain syndrome between 2011 and 2015 who underwent bladder hydrodistention. Assessments in each patient included a detailed history and physical examination, ICPI (Interstitial Cystitis Problem Index), ICSI (Interstitial Cystitis Symptom Index) and PUF (Pelvic Pain and Urgency/Frequency Patient Symptom Scale). Bladder capacity was determined during bladder hydrodistention with the patient under general anesthesia. Mean age was 45.8 years and mean bladder capacity was 857 ml in the 110 enrolled patients. We found a significant inverse correlation between bladder capacity and scores on 3 gold standard interstitial cystitis/bladder pain syndrome metrics, including ICPI (p = 0.0014), ICSI (p = 0.0022) and PUF (p = 0.0009) as well as urination frequency (p = 0.0025). Women with higher bladder capacity were significantly more likely to report depression (p = 0.0059) and irritable bowel syndrome (p = 0.022). Low bladder capacity while under anesthesia was significantly associated with high symptom scores on 3 validated interstitial cystitis/bladder pain syndrome questionnaires as well as with urinary frequency. However, it was not associated with depression or other common systemic pain problems. These results suggest that low bladder capacity is a marker for a bladder

  6. Bladder Diverticulitis: A Case Report

    PubMed Central

    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. PMID:23326691

  7. 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.

  8. 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.

  9. 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

  10. 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

  11. Hypertrophic Obstructive Cardiomyopathy Masked by Tako-Tsubo Syndrome: A Case Report

    PubMed Central

    Daralammori, Y.; El Garhy, M.; Gayed, M. R.; Farah, A.; Lauer, B.; Secknus, M. A.

    2012-01-01

    Introduction. Left ventricular outflow obstruction might be part of the pathophysiological mechanism of Tako-tsubo cardiomyopathy. This obstruction can be masked by Tako-tsubo cardiomyopathy and diagnosed only by followup. Case Presentation. A 70-year-old female presented with Tako-tsubo cardiomyopathy and masked obstructive hypertrophic cardiomyopathy at presentation. Conclusion. Tako-tsubo cardiomyopathy typically presents like an acute MI and is characterized by severe, but transient, regional left ventricular systolic dysfunction. Prompt evaluation of the coronary status is, therefore, mandatory. The prognosis under medical treatment of heart failure symptoms and watchful waiting is favourable. Previous studies showed that LVOT obstruction might be part of the pathophysiological mechanism of TCM. This paper supports this theory. However, TCM may also mask any preexisting LVOT obstruction. PMID:24826256

  12. Kinematics of YSO Molecular Hydrogen Outflows

    NASA Astrophysics Data System (ADS)

    Salas, L.; Cruz-González, I.

    2002-06-01

    As part of an on-going kinematical survey of molecular outflows, we describe observations of the 2.12 mu m line of H[2] for objects such as OMC-1, HH 211, HH 212, DR 21, Ceph A and S187-IR . The observations were made with the CAMILA IR-camera and an imaging Fabry-Pérot etalon at the 2.12 m telescope of the Observatorio Astronómico Nacional in San Pedro Mártir. A 22 km s-1 (FWHM) resolution allows us to determine the global kinematics of these sources. We show that many of them are consistent with theoretical models such as the jet driven molecular outflow paradigm. A flux versus velocity relation, similar to the one observed for CO outflows, is revealed by H[2] velocity structure.

  13. 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.

  14. Platelet Derived Growth Factor Has a Role in Pressure Induced Bladder Smooth Muscle Cell Hyperplasia and Acts in a Paracrine Way.

    PubMed

    Preis, Laura; Herlemann, Annika; Adam, Rosalyn M; Dietz, Hans-Georg; Kappler, Roland; Stehr, Maximilian

    2015-12-01

    Bladder outlet obstruction is a finding in many urological disorders, leading to bladder wall hyperplasia. We investigated platelet derived growth factor and its receptor in human bladder smooth muscle cells and urothelial cells exposed to hydrostatic pressure or PDGF in vitro. Bladder smooth muscle cells and urothelial cells were exposed to elevated hydrostatic pressure for 1 hour. The expression of PDGF and PDGFR was evaluated using reverse transcriptase-polymerase chain reaction and Western blot analysis. Pressure or PDGF induced proliferation of bladder smooth muscle cells with or without pretreatment with lovastatin or imatinib was measured by enzyme-linked immunosorbent assay. PDGFRα was knocked down with siRNA. After hydrostatic pressure bladder smooth muscle cells showed increased PDGFRα and β expression. PDGF was not expressed in bladder smooth muscle cells. Urothelial cells showed no expression of PDGFR but PDGF expression was noted. Western blot analysis of bladder smooth muscle cells revealed a pressure induced increase in PDGFR in the membrane fraction. Phosphorylation of PDGFR occurred with pressure induction. Bladder smooth muscle cell proliferation was increased in pressure and PDGF mediated fashion. Pretreatment with lovastatin or imatinib prevented proliferation. There was no cell proliferation after PDGFRα knockdown. Increased expression and phosphorylation of PDGFR in bladder smooth muscle cells after hydrostatic pressure suggests a pivotal role of the PDGF pathway in pressure induced hyperplasia of bladder smooth muscle cells. PDGF expressed in urothelial cells may act in a paracrine way. Cholesterol depletion, inhibition of receptor tyrosine kinase activity and knockdown of PDGFRα in bladder smooth muscle cells prevent pressure and PDGF mediated cell proliferation. Targeting PDGFR seems a promising way to influence pressure induced bladder wall hyperplasia. Copyright © 2015 American Urological Association Education and Research, Inc

  15. Teardrop bladder: additional considerations

    SciTech Connect

    Wechsler, R.J.; Brennan, R.E.

    1982-07-01

    Nine cases of teardrop bladder (TDB) seen at excretory urography are presented. In some of these patients, the iliopsoas muscles were at the upper limit of normal in size, and additional evaluation of the perivesical structures with computed tomography (CT) was necessary. CT demonstrated only hypertrophied muscles with or without perivesical fat. The psoas muscles and pelvic width were measured in 8 patients and compared with the measurements of a control group of males without TDB. Patients with TDB had large iliopsoas muscles and narrow pelves compared with the control group. The psoas muscle width/pelvic width ratio was significantly greater (p < 0.0005) in patients with TDB than in the control group, with values of 1.04 + 0.05 and 0.82 + 0.09, respectively. It is concluded that TDB is not an uncommon normal variant in black males. Both iliopsoas muscle hypertrophy and a narrow pelvis are factors that predispose a patient to TDB.

  16. Involvement of TL1A and DR3 in induction of ischaemia and inflammation in urinary bladder dysfunction in the elderly.

    PubMed

    Wang, Wei; Zhang, Ning; Zhu, Xu-Hui; He, Zhi-Song; Wahafu, Wasilijiang; Xu, Zhi-Qing; Yang, Yong

    2012-08-01

    Benign prostatic hyperplasia often causes intravesical obstruction in elderly men; however, the processes of aging and bladder outlet obstruction independently evoke alterations in the structure and function of the bladder. These changes lead to lower urinary tract symptoms; however, it is difficult to separate the effects of prostatic obstruction on the bladder from those of aging. Nevertheless, few studies have focused on elucidating the pathophysiological mechanisms in the aged bladder. Bladder dysfunction due to detrusor instability (caused by old age) is considered to be associated with chronic ischaemia and inflammation. The aim of this study was to explore the role of tumour necrosis factor (TNF)-like ligand 1A (TL1A) and death-domain receptor (DR)3 in the ischaemic and inflammatory process of aged bladder dysfunction. Sixteen bladder tissue samples collected from patients with urothelial tumours of the bladder were divided into two groups according to age: group 1 (controls, n=8) and group 2 (aged group, n=8). Urodynamic examinations were preformed before radical cystectomy. The full-thickness bladder tissues were obtained at least 5 cm away from the margin of the tumours. The mRNA expression levels of TL1A, DR3, von Willebrand factor (vWF), interleukin (IL)-6 and nerve growth factor (NGF) in the two groups were determined using real-time reverse transcription-PCR and the protein expression levels of TL1A, DR3 and p65 were determined by western blot analysis. The TL1A and DR3 mRNA and protein expression levels of the aged bladders were upregulated compared to the control group (p<0.05). Compared to the control, the mRNA expression levels of vWF in the aged bladder tissues were markedly lower (p<0.01); however, the mRNA expression levels of IL-6 were significantly higher in the aged bladder tissues (p<0.01) compared to the control. No significant difference in NGF mRNA expression between the two groups was detected (p>0.05). In conclusion, the aged bladder

  17. Molecular Outflows from Newly Formed Massive Stars

    NASA Astrophysics Data System (ADS)

    Kim, Kee-Tae; Kim, Won-Ju; Kim, Chang-Hee

    2015-12-01

    We map 6 massive young stellar objects (YSOs) in the CO J=2-1 line and survey 18 massive YSOs, including the six, in the hcopj, sioj, water 6_{16}-5_{23} maser, and methanol 7_{0}-6_{1} A^{+} maser lines. We detect CO bipolar outflows in all the six mapped sources. Four of them are newly discovered (ifive, ieight, inine, iten), while itwo is mapped in the CO J=2-1 line for the first time. The detected outflows are much more massive and energetic than outflows from low-mass YSOs with masses >20 M_⊙ and momenta >300 M_⊙ km/s. They have mass outflow rates (3-6)×10^{-4} M_⊙ yr^{-1}, which are at least one order of magnitude greater than those observed in low-mass YSOs. We detect hcop and SiO line emission in 18 (100%) and 4 (22%) sources, respectively. The hcop spectra show high-velocity wings in 11 (61%) sources. We detect water maser emission in 13 (72%) sources and 44 GHz methanol maser emission in 8 (44%) sources. Of the detected sources, 5 water and 6 methanol maser sources are new discoveries. iseven shows high-velocity (>30 kms) water maser lines. We find good correlations of the bolometric luminosity of the central (proto)star with the mechanical force, mechanical luminosity, and mass outflow rate of molecular outflow %L_{bol} with F_{m}, L_{m}, and dot{M}_{out} in the bolometric luminosity range of 10^{-1}-10^6 lsol, and identified 3 intermediate- or high-mass counterparts of Class O objects.

  18. 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).

  19. 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.

  20. Treatment of superficial bladder cancer.

    PubMed Central

    Morales, A.

    1980-01-01

    Most patients with bladder cancer initially present with localized, potentially curable tumours. Endoscopic surgery offers the best opportunity to eliminate these early lesions, but the rate of tumour recurrence after adequate resection is high (around 70%). Conventional methods of treatment have a place in the management of early bladder neoplasms, but their success rate is still unsatisfactory and they frequently fail to decrease the risk of recurrence. New drugs and more effective forms of administration have enhanced the use of chemotherapeutic agents. Fundamentally different approaches, such as specific immunotherapy, the use of laser energy and photodynamic therapy, are emerging as valuable approaches in the treatment of superficial bladder cancer and the prevention of recurrence. Randomized trials to assess their value and a concerted multidisciplinary effort with combined treatment give hope for effective control of early bladder cancer. PMID:6770987

  1. Treatment of superficial bladder cancer.

    PubMed

    Morales, A

    1980-05-24

    Most patients with bladder cancer initially present with localized, potentially curable tumours. Endoscopic surgery offers the best opportunity to eliminate these early lesions, but the rate of tumour recurrence after adequate resection is high (around 70%). Conventional methods of treatment have a place in the management of early bladder neoplasms, but their success rate is still unsatisfactory and they frequently fail to decrease the risk of recurrence. New drugs and more effective forms of administration have enhanced the use of chemotherapeutic agents. Fundamentally different approaches, such as specific immunotherapy, the use of laser energy and photodynamic therapy, are emerging as valuable approaches in the treatment of superficial bladder cancer and the prevention of recurrence. Randomized trials to assess their value and a concerted multidisciplinary effort with combined treatment give hope for effective control of early bladder cancer.

  2. Radiation-induced bladder carcinoma

    SciTech Connect

    Uyama, T.; Nakamura, S.; Moriwaki, S.

    1981-01-01

    Two cases are presented of radiation-induced bladder carcinoma which followed prior irradiation for cervical carcinoma of the uterus. One was a sixty-eight-year-old woman with bladder carcinoma fourteen years after irradiation (total dose of 4,500 rad) for cervical carcinoma of the uterus. The other was a sixty-four-year-old woman with bladder carcinoma twenty-five years after irradiation with 150-K volt apparatus for cervical carcinoma of the uterus. From the late radiation change of the skin, it was estimated that the total dose of prior radiation might be 4,000 rad or more. Both had high-grade, high-stage transitional cell bladder carcinoma, and the former was with marked mucus-forming adenomatous metaplasia.

  3. Endemic bladder calculi in children.

    PubMed

    Soliman, Neveen A; Rizvi, S Adibul Hasan

    2016-11-15

    Urinary calculi are being recognized more frequently in children and the urinary bladder is the most common site for stone formation in the lower urinary tract. Bladder calculi are grouped into three basic categories: primary idiopathic/endemic, secondary, and migrant. The incidence of vesical calculi has declined significantly in the last 70 years in developed nations owing to improvements in nutrition and socioeconomic conditions, but it is still high in developing nations. Primary idiopathic/endemic bladder calculi typically occur in children, in the absence of urinary tract infection (UTI), urinary stasis, or foreign body, and diet lacking in animal proteins is the major contributor factor. Comprehensive preventive and treatment strategies are critical for improving the quality of life of diseased children, in addition to helping to eradicate, or at least decrease, the incidence of endemic bladder calculi in developing nations.

  4. Assessing continence with bladder ultrasound.

    PubMed

    Addison, Ray

    Ray Addison outlines the principal uses of portable bladder ultrasound and reminds readers of the importance of reviewing the results of this investigation with other clinical investigations and the patient's health status.

  5. [Evolution of urinary bladder substitution].

    PubMed

    Kock, N G

    1992-11-01

    The historical background to the currently used methods for continent bladder substitution is shortly outlined. The significance for the patient's quality of life of various methods for bladder reconstruction or urinary diversion is briefly discussed. The importance of reservoir configuration for achieving a high compliant urinary receptacle is pointed out. Factors affecting reabsorption of urinary constituents are stressed and the significance of an antireflux mechanism is discussed. Currently the majority of patients undergoing cystectomy for cancer or for other reasons can be offered bladder substitutes providing continence and easy emptying; that is, complete control over voiding. This can be achieved by orthotopic bladder reconstruction or by diverting the urine to the augmented and valved rectum or to the skin via a continent intestinal reservoir.

  6. Bladder perforation by ventriculoperitoneal shunt.

    PubMed

    Miranda, Marcelo Eller; de Sousa, Mariana Bueno; Tatsuo, Edson Samesima; Quites, Lucas Viana; Giannetti, Alexandre Varella

    2016-12-01

    Bladder perforation by ventriculoperitoneal shunt is a rare complication that has been describe in 19 cases in prior literature. This work describes the case of a 4-month-old baby who presented with extrusion of the distal catheter through the urethra. The patient underwent a laparotomy; the catheter was cut close to the bladder wall and repositioned into the peritoneal cavity. The bladder wall was sutured, and the remaining distal portion of the catheter was removed through the urethra. Based on this single experience and a literature review, the authors classified the clinical signs and symptoms of bladder perforation by the ventriculoperitoneal shunt catheter. Finally, the authors propose a more conservative approach for this rare complication.

  7. Bladder and urethral repair - slideshow

    MedlinePlus

    ... 100002.htm Bladder and urethral repair - series—Normal anatomy To use the sharing features on this page, ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated: ...

  8. 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

  9. The CNS and bladder dysfunction

    PubMed Central

    Holstege, Gert; Griffiths, Derek J.

    2012-01-01

    The brain's role in the development and maintenance of bladder control is critical, although its precise role in patient-reported complaints such as urgency and urine leakage is unknown. Functional brain imaging studies have advanced our knowledge of brain activity during the micturition cycle, showing multiple neuronal circuits involved as parts of a ‘brain-bladder control network.’ Yet, new advances need to be made in order to incorporate this knowledge into existing models of neuroanatomy and of clinical syndromes of bladder dysfunction and related clinical practice. This short article explains why and how brain imaging methods are poised to achieve that goal and decode the role of the brain in widely prevalent clinical conditions related to bladder dysfunction. PMID:23091564

  10. Genetics Home Reference: bladder cancer

    MedlinePlus

    ... Kozlowski JM. The p53 tumor suppressor gene and nuclear protein: basic science review and relevance in the ... Zwarthoff EC, Radvanyi F. Novel fibroblast growth factor receptor 3 (FGFR3) mutations in bladder cancer previously identified ...

  11. Morphological keys in the differential diagnosis of bladder inverted papilloma. Study of two types, trabecular and glandular.

    PubMed

    Sabater Marco, Vicente; Navalón Verdejo, Pedro; Morera Faet, Arturo

    2012-09-01

    Inverted papilloma of the urinary bladder is an uncommon urothelial neoplasm that may be specially difficult to distinguish from urothelial carcinoma. Two patients with obstructive symptoms and hematuria have been studied. In the transurethral resection, accidentally, one showed a papillary lesion in the context of nodular hyperplasia of the prostate, where as the other showed a polypoid tumor of the urinary bladder Histologically, in both cases, a bladder inverted papilloma was demonstrated, originating from the surface transitional epithelium. Basal cells exhibited peripheral palisading pattern in the trabecular form. In the glandular type, Dogiel or umbrella cells into the gland-like structures, were recognized. Immunohistochemical stains for p53 and Ki-67 were negative. Umbrella cells were positive for cytokeratin 20. Two cases of bladder inverted papilloma with relevant morphological aspects are presented, which we consider useful for the differential diagnosis with urothelial carcinoma.

  12. Paradoxical Heart Failure Precipitated by Profound Dehydration: Intraventricular Dynamic Obstruction and Significant Mitral Regurgitation in a Volume-Depleted Heart

    PubMed Central

    Kim, Dongmin; Mun, Jeong-Beom; Kim, Eun Young

    2013-01-01

    Occurrence of dynamic left ventricular outflow tract (LVOT) obstruction is not infrequent in critically ill patients, and it is associated with potential danger. Here, we report a case of transient heart failure with hemodynamic deterioration paradoxically induced by extreme dehydration. This article describes clinical features of the patient and echocardiographic findings of dynamic LVOT obstruction and significant mitral regurgitation caused by systolic anterior motion of the mitral valve in a volume-depleted heart. PMID:23709446

  13. Neurogenic bladder in Hunter's syndrome.

    PubMed Central

    Koyama, K; Moda, Y; Sone, A; Tanaka, H; Hino, Y

    1994-01-01

    We encountered a rare patient with Hunter's syndrome who exhibited urinary retention as a result of a neurogenic bladder, uninhibited detrusor contractions, and detrusor-sphincter dyssynergia. Neurological findings were consistent with cervical myelopathy and cervical MR imaging showed very narrow segments at the cord level C2-4. We speculate that this Hunter's syndrome patient has cervical myelopathy and that this neurological dysfunction causes the neurogenic bladder. PMID:8014981

  14. 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.

  15. Increased residual urine in patients with bladder neuropathy secondary to suprasacral spinal cord lesions.

    PubMed

    Mayo, M E; Kiviat, M D

    1980-05-01

    Multichannel urodynamic studies were done on 30 patients with incomplete bladder emptying secondary to suprasacral spinal cord lesions. In 11 patients fluoroscopy was done simultaneously. A single most important factor accounting for the increased residual urine was present in 21 cases: inadequate detrusor contraction in 10, sphincter dyssynergia in 6 and bladder neck obstruction in 5. A combination of 2 of these factors was present in 3 patients. Although the initial residual urine volume was high in 6 patients voiding during the urodynamic study was efficient and no residual urine was demonstrated at that time. Urethral pressure profiles were variable, depending on whether a spastic external sphincter contraction was present during the procedure. It is concluded that bladder pressure and sphincter electromyographic measurement during voiding, combined with fluoroscopy, are ideal methods to identify the factors responsible for incomplete emptying in problem cases. The urethral pressure profile is of limited value in the initial assessment of these patients.

  16. Use of a percutaneous transabdominal catheter for management of obstructive urolithiasis in goats, sheep, and potbellied pigs: 69 cases (2000-2014).

    PubMed

    Chigerwe, Munashe; Heller, Meera C; Balcomb, Christie C; Angelos, John A

    2016-06-01

    OBJECTIVE To evaluate the use of a percutaneous transabdominal catheter (PTC) for urinary bladder drainage in goats, sheep, and potbellied pigs with obstructive urolithiasis. DESIGN Retrospective case series. ANIMALS 43 goats, 10 sheep, and 16 potbellied pigs (all males) with obstructive urolithiasis evaluated at the University of California-Davis Veterinary Medical Teaching Hospital. PROCEDURES Medical records of goats, sheep, and potbellied pigs examined because of obstructive urolithiasis from January 2000 through December 2014 were reviewed. Records of animals for which a standard PTC had been placed into the urinary bladder as part of disease management were selected. Data were collected regarding signalment, complications associated with PTC placement, and duration of PTC placement prior to removal. RESULTS 42 of 43 goats, 5 of 10 sheep, and all potbellied pigs were castrated. Median (range) duration of PTC placement was 2 (1 to 4) days for goats, 1 (1 to 4) day for sheep, and 1 (1 to 3) day for potbellied pigs. Complications associated with PTC placement included blockage of the catheter by urine sediment, perforation of the cecum, and migration of the catheter out of the urinary bladder. CONCLUSIONS AND CLINICAL RELEVANCE Placement of a PTC into the urinary bladder allowed for effective stabilization of goats, sheep, and potbellied pigs with obstructive urolithiasis while acid-base and electrolyte imbalances were corrected. Use of a PTC should be considered for urinary bladder drainage during medical management or prior to surgical management of obstructive urolithiasis for these species.

  17. Bladder cancer epidemiology and genetic susceptibility

    PubMed Central

    Chu, Haiyan; Wang, Meilin; Zhang, Zhengdong

    2013-01-01

    Bladder cancer is the most common malignancy of the urinary system. The incidence of bladder cancer of men is higher than that of women (approximately 4:1). Here, we summarize the bladder cancer-related risk factors, including environmental and genetic factors. In recent years, although the mortality rate induced by bladder cancer has been stable or decreased gradually, the public health effect may be pronounced. The well-established risk factors for bladder cancer are cigarette smoking and occupational exposure. Genetic factors also play important roles in the susceptibility to bladder cancer. A recent study demonstrated that hereditary non-polyposis colorectal cancer is associated with increased risk of bladder cancer. Since 2008, genome-wide association study (GWAS) has been used to identify the susceptibility loci for bladder cancer. Further gene-gene or gene-environment interaction studies need to be conducted to provide more information for the etiology of bladder cancer. PMID:23720672

  18. The neurogenic bladder: medical treatment

    PubMed Central

    Buyse, Gunnar M.

    2007-01-01

    Neurogenic bladder sphincter dysfunction (NBSD) can cause severe and irreversible renal damage and bladder-wall destruction years before incontinence becomes an issue. Therefore, the first step in adequate management is to recognize early the bladder at risk for upper- and lower-tract deterioration and to start adequate medical treatment proactively. Clean intermittent catheterization combined with anticholinergics (oral or intravesical) is the standard therapy for NBSD. Early institution of such treatment can prevent both renal damage and secondary bladder-wall changes, thereby potentially improving long-term outcomes. In children with severe side effects or with insufficient suppression of detrusor overactivity despite maximal dosage of oral oxybutynin, intravesical instillation is an effective alternative. Intravesical instillation eliminates systemic side effects by reducing the first-pass metabolism and, compared with oral oxybutynin, intravesical oxybutynin is a more potent and long-acting detrusor suppressor. There is growing evidence that with early adequate treatment, kidneys are saved and normal bladder growth can be achieved in children so they will no longer need surgical bladder augmentation to achieve safe urinary continence in adolescence and adulthood. PMID:18095004

  19. Dyssynergic vesicourethral responses during bladder rehabilitation in spinal cord injury patients: effects of suprapubic percussion, credé method and bethanechol chloride.

    PubMed

    Yalla, S V; Rossier, A B; Fam, B

    1976-05-01

    Five normal men and 70 spinal cord injury male patients underwent 100 studies with the multiple pressure recording technique, incorporating the continuous infusion principle for sphincter pressure monitoring. Gross cystosphincteric dyssynergia was noted in the majority of patients with complete upper motor neuron bladders less than 2 years in duration. Some form of synergic voiding patterns was noted, mostly in patients with incomplete upper motor neuron bladders. The external sphincter tends to be synergic in late cases of upper moto neuron bladders. Internal sphincter dyssynergia is uncommon in cases of injuries less than 2 years in duration, with the exception of patients who have autonomic dysreflexia. Bladder neck obstruction seems to be more common in late lesions secondary to global hypertrophy of the bladder. Rehabilitation maneuvers and bethanechol chloride administration may exaggerate detrusor sphincter dyssynergia and injudicious use of such procedures could be detrimental to the urinary tract.

  20. What Are the Risk Factors for Bladder Cancer?

    MedlinePlus

    ... of bladder cancer in the United States. Personal history of bladder or other urothelial cancer Urothelial carcinomas ... urinary infections and bladder cancer. Genetics and family history People who have family members with bladder cancer ...

  1. 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.

  2. 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.

  3. The HCO+ Molecular Outflow in NGC 2071

    NASA Astrophysics Data System (ADS)

    Girart, José M.; Ho, Paul T. P.; Rudolph, Alexander L.; Estalella, Robert; Wilner, David J.; Chernin, Lawrence M.

    1999-09-01

    We present high angular resolution and multitransition HCO+ observations toward the NGC 2071 molecular outflow. Comparison of the high-velocity (HV) HCO+ and the near-IR H2 in the molecular outflow shows a clear correlation. At high HCO+ flow velocities the spatial coincidence is especially remarkable. In addition, the HV HCO+ presents clear morphological and kinematical differences with the CO outflow. These differences appear not only in the HV HCO+ emission associated with the H2 but in the overall outflow. There is a clear HCO+ emission enhancement, relative to CO, at increasing flow velocities. This enhancement is probably due to an abundance enhancement produced by a velocity-dependent chemistry in the shocks. An overabundance of CH in low Mach shocks may cause the HCO+ abundance enhancement. Because of the short cooling time for H2, the correlation between the HCO+ and the H2 implies that HCO+ emission can provide a useful tool to study in detail the current interactions of protostellar winds with the dense ambient medium. At the position of the extremely high velocity (EHV) CO component in the red lobe we detect HCO+ (J=3-->2) emission within the velocity range of the EHV CO gas. This emission is roughly compatible with the expected HCO+ emission associated with EHV gas arising from behind dissociative shocks.

  4. Candidate Molecular Outflows from UC HII Regions

    NASA Astrophysics Data System (ADS)

    Shepherd, D. S.; Churchwell, E. B.

    1994-05-01

    Ultracompact (UC) HII regions surrounding deeply embedded O and B stars represent the earliest stages of massive star formation and evolution. Although much has been learned about the global properties of these active objects, we are far from understanding how massive stars form and how they impact their environments. A key to the early stages of massive star formation during the accretion/outflow phase has been the discovery that several UC HII regions (i.e. G5.89-0.39, DR 21, and W49) are at the center of massive, luminous molecular outflows. To further our understanding of the global properties of massive star evolution during this phase we must identify additional sources that are undergoing bipolar outflow. To address this issue we have performed a survey of UC HII regions to search for high velocity (12) CO(J = 1 - 0) line wings with the NRAO 12m telescope. Our results are presented here. Most of the sources observed show evidence for some high velocity gas in the wing profiles indicating that these sources are candidates for massive stars with bipolar molecular outflows. Nearly 25% of the observed sources show extreme high velocity (EHV) wings with full width zero intensity (FWZI) > 100 km s(-1) at the 50 mK level.

  5. 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.

  6. Where is the oxygen in protostellar outflows?

    NASA Astrophysics Data System (ADS)

    Kristensen, Lars

    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 seven 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.

  7. 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.

  8. Simulating Galaxy Outflows Driven by Supersonic Turbulence

    NASA Astrophysics Data System (ADS)

    Scannapieco, Evan

    Feedback from supernova-driven galaxy outflows plays a crucial role in setting the properties and assembly history of low-mass galaxies. Yet, numerically modeling such outflows has been by plagued by the fact that the underlying supernovae are much too small to be directly resolved, but have cooling times that are much too short to be modeled as thermal input. Here I will present three-dimensional, adaptive mesh simulations that overcome this problem using a subgrid model to deposit supernovae energy directly into supersonic turbulence, which acts on scales much smaller than the simulation grid spacing, but much larger than the particle mean free path. In this way, we are able to simulate a starbursting galaxy modeled after NGC 1569, including realistic radiative cooling throughout the simulation. Unlike in previous approaches, pockets of supernova-driven gas sweep up thick shells of material that persist for long times due to the cooling instability, and the overlapping of high-pressure, rarefied regions leads to a collective central outflow as observed in NGC 1569 and other outflowing starbursts. Such models will be directly comparable to a host of new observational constraints.

  9. Alignment between Protostellar Outflows and Filamentary Structure

    NASA Astrophysics Data System (ADS)

    Stephens, Ian W.; Dunham, Michael M.; Myers, Philip C.; Pokhrel, Riwaj; Sadavoy, Sarah I.; Vorobyov, Eduard I.; Tobin, John J.; Pineda, Jaime E.; Offner, Stella S. R.; Lee, Katherine I.; Kristensen, Lars E.; Jørgensen, Jes K.; Goodman, Alyssa A.; Bourke, Tyler L.; Arce, Héctor G.; Plunkett, Adele L.

    2017-09-01

    We present new Submillimeter Array (SMA) observations of CO(2–1) outflows toward young, embedded protostars in the Perseus molecular cloud as part of the Mass Assembly of Stellar Systems and their Evolution with the SMA (MASSES) survey. For 57 Perseus protostars, we characterize the orientation of the outflow angles and compare them with the orientation of the local filaments as derived from Herschel observations. We find that the relative angles between outflows and filaments are inconsistent with purely parallel or purely perpendicular distributions. Instead, the observed distribution of outflow-filament angles are more consistent with either randomly aligned angles or a mix of projected parallel and perpendicular angles. A mix of parallel and perpendicular angles requires perpendicular alignment to be more common by a factor of ∼3. Our results show that the observed distributions probably hold regardless of the protostar’s multiplicity, age, or the host core’s opacity. These observations indicate that the angular momentum axis of a protostar may be independent of the large-scale structure. We discuss the significance of independent protostellar rotation axes in the general picture of filament-based star formation.

  10. 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

  11. Outflow Entrainment and Feedback: A Case Study with HH46/47 Molecular Outflow

    NASA Astrophysics Data System (ADS)

    Zhang, Yichen; Arce, H.; Mardones, D.; Cabrit, S.

    2017-06-01

    Our ALMA multi-cycle multi-band observations of HH46/47 outflow show co-existence of entrainment by both wide-angle wind and jet bow-shock and this outflow is at a moment that the former has just become dominant. The estimated outflow mass and strength suggest that it has already strongly affected the core-to-star efficiency to 1/3 at this early stage. The zoom-in observation also reveals multiple wide outflowing shells with positions and shapes smoothly changing over a wide range of velocity, which may be an evidence of episodic eruption not only in jet but also in the wide-angle wind.

  12. Intestinal obstruction repair - slideshow

    MedlinePlus

    ... this page: //medlineplus.gov/ency/presentations/100116.htm Intestinal obstruction repair - series—Normal anatomy To use the sharing ... M. Editorial team. Related MedlinePlus Health Topics Adhesions Intestinal Obstruction A.D.A.M., Inc. is accredited by ...

  13. Intestinal obstruction (pediatric) - slideshow

    MedlinePlus

    ... this page: //medlineplus.gov/ency/presentations/100165.htm Intestinal obstruction (pediatric) - series—Normal anatomy To use the sharing ... A.M. Editorial team. Related MedlinePlus Health Topics Intestinal Obstruction A.D.A.M., Inc. is accredited by ...

  14. 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.

  15. Overactive bladder symptoms and voiding dysfunction in neurologically normal women.

    PubMed

    Espuña-Pons, Montserrat; Cardozo, Linda; Chapple, Christopher; Sievert, Karl-Dietrich; van Kerrebroeck, Phillip; Kirby, Michael G

    2012-04-01

    To understand mechanisms underlying overactive bladder (OAB) and voiding dysfunction (VD) in neurologically normal women. Review of MEDLINE from (1982) to (2011) using defined search terms, and manual analysis. Only articles published in English were included. One in five women report moderate to severe lower urinary tract symptoms (LUTS). Whilst VD is more common in men, women report a higher rate of storage symptoms or post-micturition symptoms. Post-void residual (PVR) volume measurements are vital in the assessment of women with LUTS and patients with VD without stress incontinence (SUI) are likely to have an elevated PVR (82%). Bladder outlet obstruction (BOO) also causes VD in women and can be alleviated by surgery or alpha-blocker therapy, although OAB symptoms typically remain. Surgical repair for SUI can result in temporary VD in the minority of patients, highlighting the complex interplay that is emerging in the urethral bladder functioning complex in women. Women with impaired bladder emptying present with a wide range of LUTS, and PVR measurement is essential for diagnosis. OAB and VD can clearly coexist and accurate diagnosis of underlying pathophysiology is required. Recommendations for clinical practice and research are provided including: investigation of VD in women with OAB; evaluation of PVR values to determine appropriate therapy and identification of BOO. There is clearly a need for further research into the impact of alpha-blockers in women with VD as well as an evaluation of PVR changes in women with OAB before and after antimuscarinic therapy. Copyright © 2012 Wiley Periodicals, Inc.

  16. Elective bladder-sparing treatment for muscle invasive bladder cancer.

    PubMed

    Lendínez-Cano, G; Rico-López, J; Moreno, S; Fernández Parra, E; González-Almeida, C; Camacho Martínez, E

    2014-01-01

    Radical cystectomy is the standard treatment for localised muscle invasive bladder cancer (MIBC). We offer a bladder-sparing treatment with TURB +/- Chemotherapy+Radiotherapy to selected patients as an alternative. We analyze, retrospectively, 30 patients diagnosed with MIBC from March 1991 to October 2010. The mean age was 62.7 years (51-74). All patients were candidates for a curative treatment, and underwent strict selection criteria: T2 stage, primary tumor, solitary lesion smaller than 5cm with a macroscopic disease-free status after TURB, negative random biopsy without hydronephrosis. Staging CT evaluation was normal. Restaging TURB or tumor bed biopsy showed a disease-free status or microscopic muscle invasion. 14 patients underwent TURB alone, 13 TURB+Chemotherapy and 3 TURB+Chemotherapy+Radiotherapy. The mean follow up was 88.7 months (19-220). 14 patients remained disease free (46.6%), 10 had recurrent non-muscle invasive bladder cancer (33%). 81.3% complete clinical response. 71% bladder preserved at 5-years. Overall, 5-years survival rate was 79% and 85% cancer-specific survival rate. Although radical cystectomy is the standard treatment for localised MIBC, in strictly selected cases, bladder-sparing treatment offers an alternative with good long term results. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  17. A healthy bladder: a consensus statement.

    PubMed

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

    2011-10-01

    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

  18. Comparative study of obstructive urolithiasis and its sequelae in buffalo calves

    PubMed Central

    Bayoumi, Yasmin H.; Attia, Noura E.

    2017-01-01

    Aim: The present work was designed to study the incidence of obstructive urolithiasis and to apply comparative diagnosis to urine retention cases. Materials and Methods: A total of 78 non-castrated buffalo calves aging 3-11 months were included in this study, 68 calves were admitted to the Veterinary Teaching Hospital, Zagazig University, Egypt, during the study period with a history of anuria, and they were classified into three groups; intact bladder group (19 calves), uroperitoneum group (45 calves), and ruptured urethra group (4 calves). 10 apparently healthy calves were used for comparison. On the basis of history, clinical, laboratory, and ultrasonographic findings diagnosis was achieved. Results: There was a marked increase in the incidence of obstructive urolithiasis in winter season, especially in winter months of 2016. Calves within the age of 3-4 months and 6-8 months were mostly affected. Inappetence to anorexia, restlessness or depression, and abdominal distension were the most observed signs in the diseased calves. Laboratory findings revealed hemoconcentration and a significant increase in blood urea nitrogen and serum creatinine levels in all diseased groups. Hyperproteinemia, hypocalcemia, and hyperphosphatemia with electrolytes imbalance were recorded in the uroperitoneum group. Ultrasonographically, distended urinary bladder with distal acoustic enhancement revealed obstructive urolithiasis with intact bladder while anechoic fluid in abdominal cavity indicates uroperitoneum. Conclusion: On the basis of all findings, calves with intact bladder were in superior condition than those with a ruptured urethra and both were better than those with uroperitoneum. PMID:28344397

  19. Numerical Study on Outflows in Seyfert Galaxies I: Narrow Line Region Outflows in NGC 4151

    NASA Astrophysics Data System (ADS)

    Mou, Guobin; Wang, Tinggui; Yang, Chenwei

    2017-07-01

    The origin of narrow line region (NLR) outflows remains unknown. In this paper, we explore the scenario in which these outflows are circumnuclear clouds driven by energetic accretion disk winds. We choose the well-studied nearby Seyfert galaxy NGC 4151 as an example. By performing 3D hydrodynamical simulations, we are able to reproduce the radial distributions of velocity, mass outflow rate, and kinetic luminosity of NLR outflows in the inner 100 pc deduced from spatial resolved spectroscopic observations. The demanded kinetic luminosity of disk winds is about two orders of magnitude higher than that inferred from the NLR outflows, but is close to the ultrafast outflows (UFO) detected in the X-ray spectrum and a few times lower than the bolometric luminosity of the Seyfert. Our simulations imply that the scenario is viable for NGC 4151. The existence of the underlying disk winds can be confirmed by their impacts on higher density ISM, e.g., shock excitation signs, and the pressure in NLR.

  20. THE CIRCUMBINARY OUTFLOW: A PROTOSTELLAR OUTFLOW DRIVEN BY A CIRCUMBINARY DISK

    SciTech Connect

    Machida, Masahiro N.; Inutsuka, Shu-ichiro; Matsumoto, Tomoaki E-mail: inutsuka@nagoya-u.j

    2009-10-10

    Protostellar outflow is a star's first cry at the moment of birth. The outflows have an indispensable role in the formation of single stars because they carry off the excess angular momentum from the center of the shrinking gas cloud, and permit further collapse to form a star. On the other hand, a significant fraction of stars is supposedly born as binaries with circumbinary disks that are frequently observed. Here, we investigate the evolution of a magnetized rotating cloud using a three-dimensional resistive MHD nested-grid code, and show that the outflow is driven by the circumbinary disk and has an important role even in the binary formation. After the adiabatic core formation in the collapsing cloud core, the magnetic flux is significantly removed from the center of the cloud by the Ohmic dissipation. Since this removal makes the magnetic braking ineffective, the adiabatic core continuously acquires the angular momentum to induce fragmentation and subsequent binary formation. The magnetic field accumulates in the circumbinary disk where the removal and accretion of magnetic field are balanced, and finally drives the circumbinary outflow. This result explains the spectacular morphology of some specific young stellar objects such as L1551 IRS5. We can infer that most of the bipolar molecular outflows observed by low density tracers (i.e., CO) would correspond to circumbinary or circum-multiple outflows found in this Letter, since most of the young stellar objects are supposed to be binaries or multiples.

  1. Overactive bladder in children

    PubMed Central

    Ramsay, Sophie; Bolduc, Stéphane

    2017-01-01

    Overactive bladder (OAB) is a highly prevalent disorder in the pediatric population. This condition is especially troublesome for pediatric patients and their families when associated with incontinence, since it negatively affects self-esteem and impairs children’s development. From the patient’s perspective, urgency and urge incontinence can have a significant impact, negatively affecting their quality of life. For a therapy to have true benefit, changes must not only be statistically significant, but must also be perceived as meaningful by the patient. A stepwise approach is favoured to treat this pathology, starting with behavioural therapy, followed by medical management, and eventually more invasive procedures. Antimuscarinic agents are the mainstay of medical treatment for OAB. Oxybutynin is the most commonly used antimuscarinic in the pediatric population. However, some patients have a suboptimal response to antimuscarinics and many experience bothersome side effects, which have been documented with all antimuscarinics to a significantly higher degree than placebo. Although there have been reports about the use of tolterodine, fesoterodine, trospium, propiverine, and solifenacin in children, to date, only oxybutynin has been officially approved for pediatric use by medical authorities in North America. This review will address alternative treatment options for pediatric patients presenting with OAB, from conservative measures to more invasive therapies. PMID:28265325

  2. 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.

  3. Chronic deep venous obstruction: definition, prevalence, diagnosis, management.

    PubMed

    Neglén, Peter

    2008-01-01

    Ilio-caval venous obstruction has an important role in the expression of symptomatic chronic venous disease regardless of aetiology. The presence of obstruction has been more or less previously ignored and emphasis placed on reflux alone. Stenting of the ilio-femoral veins guided by intravascular ultrasound (IVUS) can now be performed with low morbidity and mortality using appropriate technique. Current diagnostic modalities do not allow a definitive assessment of haemodynamically critical venous obstruction, which hampers selection of limbs for treatment. The diagnosis must be based on morphological studies (preferably IVUS) in patient selected with specific history, signs and symptoms. A high index of suspicion and generous use of morphological investigations are critical in the initial recognition of venous outflow obstruction. Stenting of the ilio-femoral vein appears to be durable with a substantial improvement in limb pain and swelling, high rate of ulcer healing, enhanced quality of life and decreased disability. The beneficial clinical outcome occurs regardless of the presence of remaining reflux, adjunct saphenous procedures or aetiology of obstruction.

  4. Urinary Obstruction in Prostate Cancer Patients From the Dutch Trial (68 Gy vs. 78 Gy): Relationships With Local Dose, Acute Effects, and Baseline Characteristics

    SciTech Connect

    Heemsbergen, Wilma D.; Al-Mamgani, Abrahim; Witte, Marnix G.; Herk, Marcel van; Pos, Floris J.; Lebesque, Joos V.

    2010-09-01

    Purpose: To investigate the relationship between late urinary obstruction and the details of the dose distribution of irradiated prostate cancer patients, taking into account their baseline symptoms and acute complaints. Patients and Methods: We selected patients from the Dutch multicenter trial randomized between 68 Gy and 78 Gy, for whom toxicity data and dose data were available (n = 557). The absolute dose surface parameters of the delineated bladder were calculated. Next, we constructed three-dimensional dose maps of the area around the prostate, providing an approximate identification of the corresponding anatomic locations. The dose difference maps were constructed by subtracting the mean dose maps of the patients with and without late urinary obstruction. Selected local dose points were analyzed using Cox regression analysis. Results: Urinary obstruction was scored for 40 patients, including 19 of 296 patients who received 68-72 Gy and 21 of 261 patients who received 76-78 Gy. A total of 19 events occurred within 2 years after irradiation and 21 events after 2 years. The bladder surface receiving {>=}80 Gy predicted (p <.01) the occurrence of obstruction within 2 years. The dose difference map indicated highly significant differences in the bladder neck situated in the trigonal region (p < .001) that were especially predictive of obstruction after 2 years and of the diagnosis of bladder neck obstruction. Baseline complaints and transurethral resection of the prostate and acute complaints were mainly predictive for obstruction within 2 years. Conclusion: Relatively early events of urinary obstruction were associated with urinary problems existing before RT, acute toxicity, previous transurethral resection of the prostate, and hotspots in the bladder. Events after 2 years were associated with the local dose in the trigonal area.

  5. Vesicopreputial anastomosis for the treatment of obstructive urolithiasis in goats.

    PubMed

    Cypher, Elizabeth Erin; van Amstel, Sarel R; Videla, Ricardo; Force Clark, Kyle; Anderson, David E

    2017-02-01

    To describe a novel surgical technique for the correction of recurrent obstructive urolithiasis in male goats. Clinical case series. Castrated male goats (n = 4). Medical records of male goats having undergone vesicopreputial anastomosis (VPA) as a treatment for obstructive urolithiasis were reviewed for history, signalment, clinical signs, and intraoperative and postoperative complications. Long-term follow-up (≥12 months) was obtained by telephone interview with owners or by clinical examination. All goats had undergone at least one surgical procedure (median, 2.5, range 2-4) to correct obstructive urolithiasis before undergoing VPA. Postoperative complications included premature removal of the tube from the bladder (1 goat), bacterial cystitis (2), and abscess formation (1). One goat suffered stricture of the anastomosis site 3 months following the original procedure and underwent a second VPA and 1 goat died 7 months after surgery due to severe, acute hydronephrosis and renal failure. Long-term survival ≥12 months was good with 3/4 goats (75%) or 3/5 VPA procedures (60%) having unobstructed urine flow at 12 months. Vesicopreputial anastomosis is a feasible surgical procedure for the correction of recurrent obstructive urolithiasis in male goats and one that can result in a favorable clinical outcome. Further investigation in a larger population of goats is warranted for the evaluation of the suitability of VPA in male goats with obstructive urolithiasis. © 2017 The American College of Veterinary Surgeons.

  6. Amitriptyline aggravates the fibrosis process in a rat model of infravesical obstruction

    PubMed Central

    de Almeida Prado, Patrícia S; Soares, Maria Fernanda; Lima, Flávio O; Schor, Nestor; Teixeira, Vicente PC

    2012-01-01

    Summary Infravesical obstruction (IVO) secondary to benign prostatic hypertrophy can affect up to 50% of men over 50 years old and may cause serious and irreversible alterations throughout the urinary tract, especially in the bladder. Therapeutic approaches are currently limited. Amitriptyline has recently been described as an analgesic, anti-inflammatory and myorelaxant in some experimental models. The objective of this study was to investigate the effects of amitriptyline hydrochloride on the process of fibrosis in a bladder outlet obstruction model in rats. Male Wistar rats were subjected to IVO and studied at intervals of 1 and 14 days postprocedure. The rats were randomly divided into five groups: sham, IVO1-T, IVO1-NT, IVO14-T and IVO14-NT. Bladder tissue was processed for histopathology, immunohistochemistry and RT-PCR. The IVO14 groups presented bladder fibrosis, smooth muscle cell hypertrophy and bladder wall thickening. The IVO14-T group demonstrated a higher intensity of fibrosis, higher macrophage infiltration rate and higher gene expression of Transforming growth factor (TGF) Tgf-β1. Thus this data shows that in this experimental mode amitriptyline had an amplifying effect on the process of fibrosis as a whole. PMID:22563623

  7. Treatment of the neonatal and infant megaureter in reflux, obstruction and complex congenital anomalies.

    PubMed

    de Jong, T P

    1997-06-01

    Controversy exists about the timing of surgery in neonates and infants with congenital anomalies such as refluxing and/or obstructing megaureters and ectopic ureteroceles. Discussion acuminates to the fact whether or not early reconstruction causes irreversible damage to the urodynamic properties of the bladder. Between 1986 and 1992, 49 neonates and infants with obstructing or refluxing megaureters and 23 neonates and infants with ectopic ureteroceles have been operated in our hospital with a mean follow-up of 7.3 years. Reimplant surgery consisted of a modified Politano Leadbetter procedure, ureterocele surgery consisted of complete excision of the ureterocele, including the urethral part, with reconstruction of the urethra, bladder neck and bladder base combined with ureteral reimplants. Urodynamically no unexpected changes or deteriorisation have been seen in any of the patients. Bladder capacity for age, especially in the reflux group, averages 200%. Two of the ureterocele patients needed clean intermittent catheterisation for several years. Results of reflux cure in megaureter surgery were disappointing in ureters with a flat diameter between 6 and 9 mm's that were not recalibrated leading to the conclusion that in young children recalibration of the distal ureter should be done from 6 mm's upwards. No post-operative ureteral obstruction was observed in any of the cases. The conclusion is that early major reconstructions of the lower urinary tract causes no specific harm to the urodynamic properties of the bladder and pelvic floor, provided that the surgery is performed by specialised pediatric urological surgeons. The reported urodynamic problems in this patient group are probably related to lack of experience to deal with dysfunctional voiding habits that are quite common in these children, also after successful surgery. These micturation problems are not related to the surgical procedures, they are the result of pre-existing urodynamic changes of bladder

  8. Treatment of bladder cancer. Oncology overview

    SciTech Connect

    Not Available

    1982-10-01

    Oncology Overviews are a service of the International Cancer Research Data Bank (ICRDB) Program of the National Cancer Institute, intended to facilitate and promote the exchange of information between cancer scientists by keeping them aware of literature related to their research being published by other laboratories throughout the world. Each Oncology Overview represents a survey of the literature associated with a selected area of cancer research. It contains abstracts of articles which have been selected and organized by researchers associated with the field. Contents: Surgical treatment of common bladder cancers; Radiation therapy of common bladder cancers; Chemotherapy of common bladder cancers; Immunotherapy of common bladder cancers; Multimodal treatment of common bladder cancers; Other treatment modalities of common bladder cancers; Treatment of less common bladder cancers; Reviews of treatment of bladder cancers.

  9. Genetic and Epigenetic Alterations in Bladder Cancer

    PubMed Central

    2016-01-01

    Bladder cancer is one of the most common cancers worldwide, with a high rate of recurrence and poor outcomes as a result of relapse. Bladder cancer patients require lifelong invasive monitoring and treatment, making bladder cancer one of the most expensive malignancies. Lines of evidence increasingly point to distinct genetic and epigenetic alteration patterns in bladder cancer, even between the different stages and grades of disease. In addition, genetic and epigenetic alterations have been demonstrated to play important roles during bladder tumorigenesis. This review will focus on bladder cancer-associated genomic and epigenomic alterations, which are common in bladder cancer and provide potential diagnostic markers and therapeutic targets for bladder cancer treatment. PMID:27915480

  10. Bladder Morphology Using 2 Different Catheter Designs

    ClinicalTrials.gov

    2017-04-10

    Urologic Injuries; Urologic Diseases; Bladder Infection; Urinary Tract Infections; Mucosal Inflammation; Mucosal Infection; Bladder Injury; Catheter-Related Infections; Catheter Complications; Catheter; Infection (Indwelling Catheter); Pelvic Floor Disorders; Urinary Incontinence

  11. Significance of random bladder biopsies in superficial bladder cancer.

    PubMed

    May, F; Treiber, U; Hartung, R; Schwaibold, H

    2003-07-01

    We investigated to what extent biopsies of normal-appearing urothelium taken from patients with superficial bladder cancer (Ta, T1, Tis) showed malignant disease and whether those findings had impact on therapeutical decisions. 1033 consecutive patients presenting with Ta, T1 or Tis (carcinoma in situ) superficial bladder tumors at increased risk for recurrence underwent multiple random biopsies from normal-appearing urothelium during transurethral resection (TUR). Patients with small, primary, singular tumors (smaller or equal to 1cm) were excluded from random biopsies. No tumor was found in the random biopsies of 905 patients (87.6%). 128 patients (12.4%) showed urothelial bladder cancer in their random biopsies (Tis: 74, Ta: 41, T1: 12, T2: 1). In 14 patients, where transurethral resection of the primary tumor revealed no signs of malignancy, urothelial bladder cancer was detected in the random biopsy material: Ta 8 patients, Tis 5 patients and T1 one patient. 21 patients with Ta tumors and 29 patients with T1 disease showed concomitant Tis. Upstaging of the primary, resected tumor by histological examination of the random biopsy material occurred in 75 patients (7%). Altogether, due to the random biopsy results therapy was altered in 70 patients (6.8%) of our series: It changed intravesical chemotherapy to BCG in 45, provoked a second TUR in 48 and cystectomy in 15 patients. While the clinical significance of random biopsies is still controversial, random biopsy results had strong impact on therapeutical decisions in our series. Regarding random bladder biopsies a simple tool for the urologist to identify high risk groups of patients, we recommend them as part of the routine management of superficial bladder cancer.

  12. Nicotine interferes with purinergic signaling in smooth muscle cells isolated from urinary bladders of patients with lower urinary tract symptoms.

    PubMed

    Jenes, Agnes; Szigeti, Gyula P; Ruzsnavszky, Ferenc; Varga, Attila; Lorincz, Laszlo; Csernoch, Laszlo

    2013-09-01

    In patients with outlet obstruction, the contraction of the base is reduced compared to that of healthy individuals, while the contraction of the dome is not affected. Here, we investigated the cellular mechanisms that might be responsible for cholinergic effects blocking non-adrenergic non-cholinergic contractions in the base of the urinary bladder. Smooth muscle cells either from the base or from the dome of human urinary bladders were cultured to determine the contribution of cholinergic and purinergic mechanisms to their Ca2+ homeostasis. While ATP evoked Ca2+ transients in all the cells, nicotine and carbachol induced Ca2+ transients only in 56% and 44% of the cells, respectively. When ATP was administered together with nicotine or carbachol, the amplitudes of the Ca2+ transients recorded from cells prepared from the base of bladders were significantly smaller (42 ± 6% with nicotine and 56 ± 9% with carbachol) than those evoked by ATP alone. This inhibition was much less apparent in the dome of bladders. The inhibition between the cholinergic and purinergic signaling pathways reported in this work may decrease the strength of the contraction of the base of the urinary bladder in patients with outlet obstruction during voiding.

  13. Static T2w MRU in noncalcular urinary obstruction: comparison of its two techniques.

    PubMed

    Abou El-Ghar, Mohamed; Shokeir, Ahmed; Rafaie, Huda; El-Diasty, Tarek

    2008-04-20

    The purpose of this study was to compare the diagnostic accuracy of T2-weighted (T2w) MR urography (MRU) techniques - the standard MRU using fast spin echo (FSE) and postprocessing maximum intensity projection (MIP) and the single-shot MRU - in the diagnosis of ureteric obstruction in patients with noncalcular urinary obstruction. The study included 150 patients admitted to our center between January 2005 and December 2006. There were 203 renal units with noncalcular obstruction; 53 patients had bilateral obstruction. Patients with calcular obstruction were excluded. There were 85 males and 65 females with a mean age of 50 (range: 5-83) years. All patients were examined with static MRU using both single-shot (thick slab) and multisection MRU. Using single-shot MRU, we obtained images at the direct coronal and oblique coronal, as well as sagittal, planes for each renal unit. Postprocessing MIP for the standard coronal heavy T2 source images to obtain coronal and oblique images was done. Among the obstructed 203 units, the intrinsic causes were present in 157 units (151 were stricture and six were ureteric tumors), while the extrinsic causes were present in 46 units (35 bladder tumor, four ureterocele, five retroperitoneal fibrosis, one prostatic tumor, and one local pelvic recurrence after radical cystectomy for bladder cancer). The overall accuracy of single-shot MRU was 89% and was 93% for the multisection MRU in cases of intrinsic ureteric obstruction, while in cases of extrinsic obstruction, it was 20% for single-shot MRU and 96% for multisection MRU. T2w static MRU is a very useful technique in diagnosing noncalcular ureteric obstruction. Multisection MRU has a high diagnostic accuracy and reliability over that of the single-shot technique. The single-section technique is very rapid and useful in diagnosing ureteric stricture so it could be used as a localizer, while multisection images with postprocessing MIP is mandatory, especially in cases of suspected

  14. Differential expression of vascular endothelial growth factor, and angiopoietin 1 and 2 in functionally divergent experimental rabbit models of bladder hypertrophy.

    PubMed

    Walker, Adam; Tanner, Matthew J; Husson, Paul; Schuler, Catherine; Kogan, Barry A; Buttyan, Ralph; Levin, Robert M

    2009-06-01

    Partial bladder outlet obstruction or ovariectomy with subsequent estrogen replenishment induces bladder hypertrophy in rabbits and yet the functional outcomes of these procedures differ. We investigated whether these models might be distinguished by differential expression of the genes controlling angiogenesis. Groups of male rabbits underwent sham surgery or partial bladder outlet obstruction for 1 or 2 weeks. Groups of females underwent sham surgery, ovariectomy or ovariectomy plus estrogen for 1 or 2 weeks. Bladders from each group were weighed and assayed for the contractile response, smooth muscle content and vascular density. Mucosa and muscle layers were separated and RNA from the fractions was assayed by quantitative real-time polymerase chain reaction to measure the relative expression of vascular endothelial growth factor, and angiopoietin 1 and 2 mRNA. Male bladders with partial outlet obstruction had attributes that typified hypertrophy with a loss of contractile function. Vascular endothelial growth factor expression was up-regulated in the mucosa and muscle layers but the effect was most pronounced in mucosa. Angiopoietin 1 expression was significantly up-regulated in muscle. Female bladders with ovariectomy plus estrogen had attributes that typified bladder hypertrophy with increased contractile function. Vascular endothelial growth factor expression was up-regulated early in mucosa but more highly and consistently increased in muscle. Angiopoietin 1 and 2 expression was not significantly affected. Although these models have similar outcomes with regard to bladder hypertrophy, they have opposite functional outcomes that coincide with compartmental differences in the expression of genes involved in the regulation of angiogenesis. The disparity in gene expression might explain the difference in the functional outcomes.

  15. Accretion, winds and outflows in young stars

    NASA Astrophysics Data System (ADS)

    Günther, H. M.

    2013-02-01

    Young stars and planetary systems form in molecular clouds. After the initial radial infall an accretion disk develops. For classical T Tauri stars (CTTS, F-K type precursors) the accretion disk does not reach down to the central star, but it is truncated near the co-rotation radius by the stellar magnetic field. The inner edge of the disk is ionized by the stellar radiation, so that the accretion stream is funneled along the magnetic field lines. On the stellar surface an accretion shock develops, which is observed over a wide wavelength range as X-ray emission, UV excess, optical veiling and optical and IR emission lines. Some of the accretion tracers, e.g. Hα, can be calibrated to measure the accretion rate. This accretion process is variable on time scales of hours to years due to changing accretion rates, stellar rotation and reconfiguration of the magnetic field. Furthermore, many (if not all) accreting systems also drive strong outflows which are ultimately powered by accretion. However, the exact driving mechanism is still unclear. Several components could contribute to the outflows: slow, wide-angle disk winds, X-winds launched close to the inner disk rim, and thermally driven stellar winds. In any case, the outflows contain material of very different temperatures and speeds. The disk wind is cool and can have a molecular component with just a few tens of km s-1, while the central component of the outflow can reach a few 100 km s-1. In some cases the inner part of the outflow is collimated to a small-angle jet. These jets have an onion-like structure, where the inner components are consecutively hotter and faster. The jets can contain working surfaces, which show up as Herbig-Haro knots. Accretion and outflows in the CTTS phase do not only determine stellar parameters like the rotation rate on the main-sequence, they also can have a profound impact on the environment of young stars. This review concentrates on CTTS in near-by star forming regions where

  16. Azoospermia in an 8-month-old boar due to bilateral obstruction at the testis/epididymis interface

    PubMed Central

    Clements, Kristin M.; Shipley, Clifford F.; Coleman, David A.; Ehrhart, Eugene J.; Haschek, Wanda M.; Clark, Sherrie G.

    2010-01-01

    An 8-month-old Yorkshire boar was presented for apparent azoospermia. Two semen collections also revealed azoospermia. Ultrasonographic examination of the gonads revealed bilateral caput epididymal dilatation and anechoic fluid within the tubules. Because a testicular biopsy revealed normal spermatogenesis, an outflow tract obstruction was suspected. Multiple sperm granulomas were found within the parenchyma of both testes at necropsy. PMID:21197205

  17. Molecular pathology and biomarkers of bladder cancer.

    PubMed

    Czerniak, Bogdan

    2010-01-01

    Bladder cancer originates in the epithelial lining of the bladder's mucosa and develops in association with several habitual, industrial, and environmental risk factors via papillary and non-papillary pathways. In this chapter we review novel concepts concerning the molecular mechanisms of early field change in bladder neoplasia stemming from whole-organ genomic mapping studies. These mechanisms are discussed in the context of molecular pathogenesis of bladder cancer and in relation to treatment and biomarker-based detection strategies.

  18. Gall bladder malignancy: an unusual association.

    PubMed

    Appukutty, Sona J; Worthington, Tim; Bagwan, Izhar N

    2013-06-01

    Gall bladder malignancy predominantly comprises adenocarcinoma and is found mostly in a late stage whereas primary lymphoma of mucosa associated lymphoid tissue (MALT) within the gall bladder is exceedingly rare and has an incidental presentation. We report a case of well differentiated adenocarcinoma with MALT lymphoma of the gall bladder in an 83 year old woman. To our knowledge, this is the first case of a carcinoma and lymphoma occurring simultaneously in the gall bladder.

  19. Surgical treatment of urethral obstruction due to urolithiasis in male cattle: a review of 85 cases.

    PubMed

    Gasthuys, F; Steenhaut, M; De Moor, A; Sercu, K

    1993-11-20

    Eighty-five male cattle with urethral obstruction due to urolithiasis were treated by surgery. In most cases local anaesthetic techniques combined with sedation were applied to the dorsally recumbent animals. The penis was transected and transposed in animals with a ruptured urethra. A ruptured bladder was repaired by a paramedian abdominal approach. The bladder was fistulated through the ventral abdominal wall when no alternative treatment was possible. Complications related to the different surgical interventions are described. Only 35.3 per cent of the animals recovered satisfactorily.

  20. 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.

  1. Bladder trauma: multidetector computed tomography cystography.

    PubMed

    Ishak, Charbel; Kanth, Nalini

    2011-08-01

    Multidetector computed tomography (MDCT) cystography is rapidly becoming the most recommended study for evaluation of the bladder for suspected trauma. This article reviews the bladder trauma with emphasis on the application of MDCT cystography to traumatic bladder injuries using a pictorial essay based on images collected in our level I trauma center.

  2. 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

  3. Circulating Biomarkers in Bladder Cancer

    PubMed Central

    Nandagopal, Lakshminarayanan; Sonpavde, Guru

    2016-01-01

    Bladder cancer is a molecularly heterogeneous disease characterized by multiple unmet needs in the realm of diagnosis, clinical staging, monitoring and therapy. There is an urgent need to develop precision medicine for advanced urothelial carcinoma. Given the difficulty of serial analyses of metastatic tumor tissue to identify resistance and new therapeutic targets, development of non-invasive monitoring using circulating molecular biomarkers is critically important. Although the development of circulating biomarkers for the management of bladder cancer is in its infancy and may currently suffer from lower sensitivity of detection, they have inherent advantages owing to non-invasiveness. Additionally, circulating molecular alterations may capture tumor heterogeneity without the sampling bias of tissue biopsy. This review describes the accumulating data to support further development of circulating biomarkers including circulating tumor cells, cell-free circulating tumor (ct)-DNA, RNA, micro-RNA and proteomics to improve the management of bladder cancer. PMID:28035318

  4. [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.

  5. Bladder cavernous hemangioma. Case report.

    PubMed

    Rodriguez Collar, Tomás Lázaro; Casa de Valle Castro, Midalys; Báez Sarría, Felix; Trujillo Fernández, Reinerio

    2014-07-01

    To report a case of a bladder cavernous hemangioma, as well as the main features of its diagnosis and treatment. A 74 year old patient, regular smoker, presented with total macroscopic hematuria of moderate intensity with large rounded clots. On physical examination the patient's mucous membranes color was normal, and digital rectal examination showed a normal size prostate with fibroelastic consistency. An abdominal ultrasound was performed showing a slight bladder bottom thickening in addition to free clots and a homogeneous and normal prostate. Cystoscopy confirmed the presence of a sessile violet-colored rounded retrotrigonal tumor, 2 cm in diameter and 0.5 in height; it was immediately resected. The pathological study reported cavernous hemangioma. Patient's evolution has been satisfactory. Bladder cavernous hemangioma is a rare cause of hematuria, and transurethral resection of the small size lesions constitutes an effective option as a definitive surgical treatment.

  6. 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.

  7. 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.

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

    PubMed Central

    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

  9. 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.

  10. Eddy Generation by a Steady Poleward Outflow

    NASA Astrophysics Data System (ADS)

    Durland, T. S.; Pedlosky, J.; Spall, M. A.

    2008-12-01

    The energetic eddy field coincident with the South Equatorial Current (SEC) in the eastern Indian Ocean has been variously attributed to baroclinic instability of the SEC, barotropic instability of the SEC and shedding of eddies by the branch of the Indonesian Throughflow (ITF) entering the basin through Timor Passage. We present an additional mechanism by demonstrating that in an idealized numerical model, a steady poleward outflow (meant to simulate the Lombok Strait branch of the ITF) can generate an eddy field with spatial and temporal patterns that bear a remarkable resemblance to observations of sea surface height varibility in the region. A simple conceptual model will be presented which links the nonlinear, eddy-generating dynamics to linear dynamics, thus making possible the prediction of eddy amplitudes and periodicity for a wide range of outflow latitudes and volume fluxes.

  11. Mixing and Dynamics of the Mediterranean Outflow

    DTIC Science & Technology

    1994-02-01

    Committee for Physical Oceanography Massachusetts Institute of Technology/ Woods Hole Oceanographic Institution 2 MIXING AND DYNAMICS OF THE...isopycnal becomes more than a 2 °C. The flow eventually settles along two preferred isopycnals: 27.5 and 27.8 (Zenk 1975b). The spreading of the flow...on the outflow. This stress is as large as 5 Pa within 20 km of the Strait, while further downstream the stress decreases to about 1 Pa. The 2

  12. THE OUTFLOWING WIND OF V1057 CYGNI

    SciTech Connect

    Herbig, G. H.

    2009-08-15

    In 1970-1971, V1057 Cyg rose from about m {sub pg} {approx} 16 to a peak near 10.5 mag. It has subsequently faded to about B = 15, and although it appeared to be a T Tauri star (TTS) before the outburst, it now resembles a rather peculiar rapidly rotating G-type supergiant. Before the outburst, it showed unmistakable evidence of high-velocity outflow (by the suppression of emission Ca II {lambda}3968 by the P Cyg absorption component of H{epsilon} {lambda}3970). Such outflow absorptions are currently found at many strong lines (H{alpha}, Na I D{sub 1,2}, K I {lambda}{lambda}7664, 7698, Ca II {lambda}{lambda}8498, 8662, ...). The same phenomenon has since been observed in a number of other FUors near maximum light, suggesting that it is a FUor characteristic that clearly differs from the outflows found in TTSs. The Li I resonance line at 6707 A is relatively weak, and on high-resolution spectra obtained between 1997 and 2008 showed variable absorption structure on its shortward side that probably represents wind structure that is lost in the stronger lines. In addition, a narrow emission line at 6707 A persists throughout the series and is the counterpart of the sharp emission lines that occur near the centers of many of the broad stellar absorption lines (v sin i = 55 km s{sup -1}) and that were responsible for the line-splitting phenomenon formerly regarded as evidence of a Keplerian disk. Given the evidence of a quasi-permanent outflow at V1057 Cyg, the hypothesis is advanced that a FUor outburst may be the result of a rapidly rotating TTS having contracted to a point of rotational instability, at which time it sheds enough material and angular momentum to resume contraction, until the next such event.

  13. Molecular outflow launched beyond the disk edge

    NASA Astrophysics Data System (ADS)

    Alves, F. O.; Girart, J. M.; Caselli, P.; Franco, G. A. P.; Zhao, B.; Vlemmings, W. H. T.; Evans, M. G.; Ricci, L.

    2017-07-01

    One of the long-standing problems of star formation is the excess of angular momentum of the parent molecular cloud. In the classical picture, a fraction of angular momentum of the circumstellar material is removed by the magneto-centrifugally driven disk wind that is launched from a wide region throughout the disk. In this work, we investigate the kinematics in the envelope-disk transition zone of the Class I object BHB07-11, in the B59 core. For this purpose, we used the Atacama Large Millimeter/submillimeter Array in extended configuration to observe the thermal dust continuum emission (λ0 1.3 mm) and molecular lines (CO, C18O and H2CO), which are suitable tracers of disk, envelope, and outflow dynamics at a spatial resolution of 30 AU. We report a bipolar outflow that was launched at symmetric positions with respect to the disk ( 80 AU in radius), but was concentrated at a distance of 90-130 AU from the disk center. The two outflow lobes had a conical shape and the gas inside was accelerating. The large offset of the launching position coincided with the landing site of the infall materials from the extended spiral structure (seen in dust) onto the disk. This indicates that bipolar outflows are efficiently launched within a narrow region outside the disk edge. We also identify a sharp transition in the gas kinematics across the tip of the spiral structure, which pinpoints the location of the so-called centrifugal barrier.

  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. Immunobiology of human bladder cancer.

    PubMed

    Herr, H W

    1976-02-01

    The immune destruction of bladder cancer most likely results from an interaction of specific and non-specific cellular and humoral responses evoked by tumor-associated antigens. We are just beginning to comprehend the complex immune mechanisms operating to retard or facilitate tumor growth in patients with this disease. This understanding has led to renewed hope that the immune system may be manipulated for the benefit of the tumor-bearing patient. However, only a thorough understanding of the basic functions of the immune system in man will permit a rational approach to immunotherapy in patients with bladder cancer.

  17. 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.

  18. 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.

  19. Density distributions of outflow-driven turbulence

    NASA Astrophysics Data System (ADS)

    Moraghan, Anthony; Kim, Jongsoo; Yoon, Suk-Jin

    2013-05-01

    Protostellar jets and outflows are signatures of star formation and promising mechanisms for driving supersonic turbulence in molecular clouds. We quantify outflow-driven turbulence through three-dimensional numerical simulations using an isothermal version of the robust total variation diminishing code. We drive turbulence in real space using a simplified spherical outflow model, analyse the data through density probability distribution functions (PDFs), and investigate the core formation rate per free-fall time (CFRff). The real-space turbulence-driving method produces a negatively skewed density PDF possessing an enhanced tail on the low-density side. It deviates from the log-normal distributions typically obtained from Fourier-space turbulence driving at low densities, but can provide a good fit at high densities, particularly in terms of mass-weighted rather than volume-weighted density PDF. Due to this fact, we suggest that the CFRff determined from a Fourier-driven turbulence model could be comparable to that of our particular real-space-driving model, which has a ratio of solenoidal to compressional components from the resulting turbulence velocity fields of ˜0.6.

  20. Magnetospheric imaging of high latitude ion outflows

    NASA Technical Reports Server (NTRS)

    Garrido, D. E.; Robinson, R. M.; Chiu, Y. T.; Collin, H. L.; Smith, R. W.; Swift, D. W.

    1994-01-01

    High latitude ion outflows mostly consist of upward streaming O(+) and He(+) emanating from the ionosphere. At heights above 1000 km, these flows consist of cold and hot components which resonantly scatter solar extreme ultraviolet (EUV) light, however, the ion populations respond differently to Doppler shifting resulting from the large relative velocities between the ions and the Sun. The possibility of optical detection of the Doppler effect on the scattering rate will be discussed for the O(+) (83.4 nm) ions. We have contrasted the EUV solar resonance images of these outflows by simulations of the 30.4 nm He(+) and 83.4 nm O(+) emissions for both quiet and disturbed geomagnetic conditions. Input data for the 1000 km level has been obtained from the EICS instrument aboard the Dynamics Explorer (DE) satellite. Our results show emission rates of 50 and 56 milli-Rayleighs at 30.4 nm for quiet and disturbed conditions and 65 and 75 milli-Rayleighs at 83.4 nm for quiet and disturbed conditions, respectively, obtained for a polar orbiting satellite and viewing radially outward. We also find that an imager at an equatorial distance of 9 R(sub E) or more is in a favorable position for detecting ion outflows, particularly when the plasmapause is depressed in latitude. However, an occultation disk is necessary to obscure the bright plasmaspheric emissions.

  1. CARMA OBSERVATIONS OF PROTOSTELLAR OUTFLOWS IN NGC 1333

    SciTech Connect

    Plunkett, Adele L.; Arce, Hector G.; Corder, Stuartt A.; Mardones, Diego; Sargent, Anneila I.; Schnee, Scott L.

    2013-09-01

    We present observations of outflows in the star-forming region NGC 1333 using the Combined Array for Research in Millimeter-Wave Astronomy (CARMA). We combined the {sup 12}CO and {sup 13}CO (1-0) CARMA mosaics with data from the 14 m Five College Radio Astronomy Observatory to probe the central, most dense, and active region of this protostellar cluster at scales from 5'' to 7' (or 1000 AU to 0.5 pc at a distance of 235 pc). We map and identify {sup 12}CO outflows, and along with {sup 13}CO data we estimate their mass, momentum, and energy. Within the 7' Multiplication-Sign 7' map, the 5'' resolution allows for a detailed study of morphology and kinematics of outflows and outflow candidates, some of which were previously confused with other outflow emission in the region. In total, we identify 22 outflow lobes, as well as 9 dense circumstellar envelopes marked by continuum emission, of which 6 drive outflows. We calculate a total outflow mass, momentum, and energy within the mapped region of 6 M{sub Sun }, 19 M{sub Sun} km s{sup -1}, and 7 Multiplication-Sign 10{sup 44} erg, respectively. Within this same region, we compare outflow kinematics with turbulence and gravitational energy, and we suggest that outflows are likely important agents for the maintenance of turbulence in this region. In the earliest stages of star formation, outflows do not yet contribute enough energy to totally disrupt the clustered region where most star formation is happening, but have the potential to do so as the protostellar sources evolve. Our results can be used to constrain outflow properties, such as outflow strength, in numerical simulations of outflow-driven turbulence in clusters.

  2. Social stress induces changes in urinary bladder function, bladder NGF content, and generalized bladder inflammation in mice.

    PubMed

    Mingin, Gerald C; Peterson, Abbey; Erickson, Cuixia Shi; Nelson, Mark T; Vizzard, Margaret A

    2014-10-01

    Social stress may play a role in urinary bladder dysfunction in humans, but the underlying mechanisms are unknown. In the present study, we explored changes in bladder function caused by social stress using mouse models of stress and increasing stress. In the stress paradigm, individual submissive FVB mice were exposed to C57BL/6 aggressor mice directly/indirectly for 1 h/day for 2 or 4 wk. Increased stress was induced by continuous, direct/indirect exposure of FVB mice to aggressor mice for 2 wk. Stressed FVB mice exhibited nonvoiding bladder contractions and a decrease in both micturition interval (increased voiding frequency) and bladder capacity compared with control animals. ELISAs demonstrated a significant increase in histamine protein expression with no change in nerve growth factor protein expression in the urinary bladder compared with controls. Unlike stressed mice, mice exposed to an increased stress paradigm exhibited increased bladder capacities and intermicturition intervals (decreased voiding frequency). Both histamine and nerve growth factor protein expression were significantly increased with increased stress compared with control bladders. The change in bladder function from increased voiding frequency to decreased voiding frequency with increased stress intensity suggests that changes in social stress-induced urinary bladder dysfunction are context and duration dependent. In addition, changes in the bladder inflammatory milieu with social stress may be important contributors to changes in urinary bladder function.

  3. 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.

  4. Outflow Kinematics Manifested by the Hα Line: Gas Outflows in Type 2 AGNs. IV.

    NASA Astrophysics Data System (ADS)

    Kang, Daeun; Woo, Jong-Hak; Bae, Hyun-Jin

    2017-08-01

    Energetic ionized gas outflows driven by active galactic nuclei (AGNs) have been studied as a key phenomenon related to AGN feedback. To probe the kinematics of the gas in the narrow-line region, [O iii] λ5007 has been utilized in a number of studies showing nonvirial kinematic properties due to AGN outflows. In this paper, we statistically investigate whether the Hα emission line is influenced by AGN-driven outflows by measuring the kinematic properties based on the Hα line profile and comparing them with those of [O iii]. Using the spatially integrated spectra of ∼37,000 Type 2 AGNs at z < 0.3 selected from the Sloan Digital Sky Survey DR7, we find a nonlinear correlation between Hα velocity dispersion and stellar velocity dispersion that reveals the presence of the nongravitational component, especially for AGNs with a wing component in Hα. The large Hα velocity dispersion and velocity shift of luminous AGNs are clear evidence of AGN outflow impacts on hydrogen gas, while relatively smaller kinematic properties compared to those of [O iii] imply that the observed outflow effect on the Hα line is weaker than the case of [O iii].

  5. [The ice water test and bladder cooling reflex. Physiology, pathophysiology and clinical importance].

    PubMed

    Hüsch, T; Neuerburg, T; Reitz, A; Haferkamp, A

    2016-04-01

    Urodynamic studies are utilised for identification and follow-up of functional disorders of the lower urinary tract. Provocation tests are used to determine disorders which could not be revealed in standard cystometry. The ice water test is a simple test to identify neurogenic bladder dysfunction and to screen the integrity of the upper motor neuron in neurogenic bladder dysfunction. Development and significance of the ice water test is presented in this review against the background of physiology and pathophysiology of the lower urinary tract. A systematic review of PubMed and ScienceDirect databases was performed in April 2015. No language or time limitation was applied. The following key words and Medical Subject Heading terms were used to identify relevant studies: "ice water test", "bladder cooling reflex", "micturition" and "neuronal control". Review articles and bibliographies of other relevant studies identified were hand searched to find additional studies. The ice water test is performed by rapid instillation of 4-8 °C cold fluid into the urinary bladder. Hereby, afferent C fibers are activated by cold receptors in the bladder leading to the bladder cooling reflex. It is a spinal reflex which causes an involuntarily contraction of the urinary bladder. The test is normally positive in young infants during the first 4 years of life and become negative with maturation of the central nervous system afterwards by inhibition of the reflex. The damage of the upper motor neuron causes the recurrence of the reflex in the adulthood and indicates spinal and cerebral lesions. The ice water test is utilised to identify lesions of the upper motor neuron. However, in the case of detrusor acontractility the test will always be negative and can not be utilized to distinguish between neurogenic or muscular causes. Furthermore, the test is also positive in a small percentage of cases of non-neurogenic diseases, e.g. in prostate-related bladder outlet obstruction or

  6. [Non obstructive retrocaval ureter].

    PubMed

    Cao Avellaneda, E; Server Pastor, G; López López, A I; Maluff Torres, A; López Cubillana, P; Rigabert Montiel, M; Pérez Albacete, M

    2005-01-01

    We report a case on circumcavum ureter without obstruction or type two, according the Batenson and Atkinson's classification, in a forty-nine year old man. It was diagnosticated for a gross haematuria and renoureteral pain, because of a simultaneous urinary tract infection. We emphasize its absence of the typical morphology and obstruction signs. After twelve months the patient is still asymptomatic, without any medical or surgical treatment.

  7. [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.

  8. 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

  9. Gall-bladder duplication - case report.

    PubMed

    Koszman, Bogusław

    2014-12-18

    Gall-bladder duplication is a rare anatomical variation, which can affect safe performance of cholecystectomy and be a cause of persistent symptoms and a need for reoperation in case of accessory gall-bladder omission. A case of successfully performed elective laparoscopic cholecystectomy in a patient with duplicated gall-bladder accidentally intraoperatively disclosed is presented. The identified anomaly was classified according to the Harlaftis Classification of Multiple Gall-bladders. Attention was drawn to the uneffectivenes of ultrasound scanning in multiple gall-bladders preoperative detecting, and presence of other non-biliary anatomical variation in the same individual as well.

  10. Molecular Outflows in Massive Star Forming Regions

    NASA Astrophysics Data System (ADS)

    Cunningham, Nichol

    2015-11-01

    This thesis presents millimetre continuum and molecular line observations exploring the properties of molecular outflows towards massive star forming regions. Massive stars produce some of the most energetic phenomena in the Galaxy, yet we still do not have a comprehensive understanding of how they actually form. Outflows are known to play a key role in this formation process and their properties, particularly how they change depending on the mass, luminosity and evolution of the driving source can shed light on how massive stars actually form. This thesis presents observations at both high (SMA 3 arcsecond) and low (JCMT 15 arcsecond) spatial resolution of the known jet/outflow tracers, SiO and 12CO, towards a sample massive star forming region drawn from the RMS survey. Furthermore, the presence of infall signatures is explored through observations of HCO+ and H13CO+, and the hot core nature of the regions is probed using tracers such as CH3CN, HC3N and CH3OH. SiO is detected towards approximately 50% of the massive young stellar objects and HII regions in the JCMT sample. The detection of SiO appears to be linked to the age of the RMS source, with the likely younger sources showing a stronger dependence with SiO. The presence of SiO also appears to be linked to the CO velocity, with SiO more efficiently tracing sources with higher velocity dispersions. In the MOPRA observations towards a sample of 33 RMS sources, CH3CN is detected towards 66% of the sources, with the redder likely younger sources having the largest rotational temperatures. This thesis presents the first interferometric SiO (5-4) and 12CO (2-1) observations, taken with the SMA, towards the massive star forming region G203.3166/NGC 2264-C. In this intermediate/massive star forming cluster, SiO is again tracing the youngest sources. Both the SiO and 12CO emission trace two bipolar, high velocity outflows towards the mm brightest, IR-dark, likely youngest sources in this reg! ion. In contrast the IR

  11. Morphology of aortic arch obstruction with patent ductus arteriosus

    PubMed Central

    Marino, Bruno; Chiariello, Luigi; Mercanti, Corrado; Bosman, Cesare; Colloridi, Vicenzo; Reale, Attilio; Marino, Benedetto

    1981-01-01

    Thirty-one hearts with aortic arch obstruction and patent ductus arteriosus were examined with special reference to associated cardiac anomalies. Six presented with complete interruption of the aortic arch, four with atretic isthmus, twelve with coarctation, and three with tubular hypoplasia. Associated cardiac anomalies were divided into two main groups: (1) septal defect with left-to-right shunt, and (2) left ventricular inflow and/or outflow obstruction. A high incidence (9/19=47.4%) of ventriculo-infundibular malalignment type of ventricular septal defect with subaortic stenosis was observed. Associated cardiac lesions that reduce blood flow in the aortic arch during fetal life may be responsible for poor development of this structure. Images PMID:15216214

  12. Rethinking the process of detrainment: jets in obstructed natural flows

    NASA Astrophysics Data System (ADS)

    Mossa, Michele; de Serio, Francesca

    2016-12-01

    A thorough understanding of the mixing and diffusion of turbulent jets released in porous obstructions is still lacking in literature. This issue is undoubtedly of interest because it is not strictly limited to vegetated flows, but also includes outflows which come from different sources and which spread among oyster or wind farms, as well as aerial pesticide treatments sprayed onto orchards. The aim of the present research is to analyze this process from a theoretical point of view. Specifically, by examining the entrainment coefficient, it is deduced that the presence of a canopy prevents a momentum jet from having an entrainment process, but rather promotes its detrainment. In nature, detrainment is usually associated with buoyancy-driven flows, such as plumes or density currents flowing in a stratified environment. The present study proves that detrainment occurs also when a momentum-driven jet is issued in a not-stratified obstructed current, such as a vegetated flow.

  13. Rethinking the process of detrainment: jets in obstructed natural flows

    PubMed Central

    Mossa, Michele; De Serio, Francesca

    2016-01-01

    A thorough understanding of the mixing and diffusion of turbulent jets released in porous obstructions is still lacking in literature. This issue is undoubtedly of interest because it is not strictly limited to vegetated flows, but also includes outflows which come from different sources and which spread among oyster or wind farms, as well as aerial pesticide treatments sprayed onto orchards. The aim of the present research is to analyze this process from a theoretical point of view. Specifically, by examining the entrainment coefficient, it is deduced that the presence of a canopy prevents a momentum jet from having an entrainment process, but rather promotes its detrainment. In nature, detrainment is usually associated with buoyancy-driven flows, such as plumes or density currents flowing in a stratified environment. The present study proves that detrainment occurs also when a momentum-driven jet is issued in a not-stratified obstructed current, such as a vegetated flow. PMID:27974835

  14. Rethinking the process of detrainment: jets in obstructed natural flows.

    PubMed

    Mossa, Michele; De Serio, Francesca

    2016-12-15

    A thorough understanding of the mixing and diffusion of turbulent jets released in porous obstructions is still lacking in literature. This issue is undoubtedly of interest because it is not strictly limited to vegetated flows, but also includes outflows which come from different sources and which spread among oyster or wind farms, as well as aerial pesticide treatments sprayed onto orchards. The aim of the present research is to analyze this process from a theoretical point of view. Specifically, by examining the entrainment coefficient, it is deduced that the presence of a canopy prevents a momentum jet from having an entrainment process, but rather promotes its detrainment. In nature, detrainment is usually associated with buoyancy-driven flows, such as plumes or density currents flowing in a stratified environment. The present study proves that detrainment occurs also when a momentum-driven jet is issued in a not-stratified obstructed current, such as a vegetated flow.

  15. Obesity, Physical Activity and Bladder Cancer.

    PubMed

    Noguchi, Jonathan L; Liss, Michael A; Parsons, J Kellogg

    2015-10-01

    While smoking and exposure to certain chemicals are well-defined risk factors for bladder cancer, there is no consensus as to the roles of modifiable lifestyle factors, notably physical activity, and obesity. We evaluated associations of obesity and physical activity with bladder cancer risk by performing a system-wide search of PubMed for cohort and case-control studies focused on obesity, exercise, and bladder cancer. A total of 31 studies were identified that evaluated the associations of obesity and physical activity with bladder cancer risk: 20 focused on obesity, eight on physical activity, and three on both. There was marked heterogeneity in population composition and outcomes assessment. Fifteen (65%) of the obesity studies used prevalence or incidence as the primary outcome and seven (30%) used bladder cancer mortality. Ten (44%) observed positive and 13 (56%) null associations of obesity with bladder cancer. Three (100%) of three studies also noted strong positive associations of obesity with bladder cancer progression or recurrence. Ten (91%) of the physical activity studies analyzed prevalence or incidence and one (9%) mortality. One (9%) study observed positive, seven (64%) null, and three (27%) negative associations of physical activity with bladder cancer. Study heterogeneity precluded quantitative assessment of outcomes. Obesity is potentially associated with an increased risk of bladder cancer, particularly for progression, recurrence, or death. Further studies of physical activity and bladder cancer are needed to validate these observations and elucidate the associations of exercise with bladder cancer progression and mortality.

  16. 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.

  17. Bladder health across the life course.

    PubMed

    Ellsworth, P; Marschall-Kehrel, D; King, S; Lukacz, E

    2013-05-01

    Influences on bladder health begin during infancy and continue throughout the lifespan. Bladder anatomy and physiology change as individuals age, and the risk and propensity for bladder conditions, including lower urinary tract symptoms, throughout life are related to factors specific to age, sex, and life events. Bladder habits and dysfunctions at one stage of life may affect bladder health in subsequent stages. However, bladder problems are neither a normal part of aging nor inevitable at any stage of life. Many of the factors that negatively impact bladder health at all ages may be modifiable, and healthy bladder habits may prevent or reverse bladder dysfunctions that can occur naturally or in response to life events. There are opportunities to further define and promote healthy bladder habits through focused research and heightened public awareness of the importance of bladder health, which may lead to improvements in overall health and quality of life. It is our hope that this paper will inform and encourage public health initiatives and research programs aimed at this goal.

  18. 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

  19. Pathobiology and Chemoprevention of Bladder Cancer

    PubMed Central

    Tanaka, Takuji; Miyazawa, Katsuhito; Tsukamoto, Tetsuya; Kuno, Toshiya; Suzuki, Koji

    2011-01-01

    Our understanding of the pathogenesis of bladder cancer has improved considerably over the past decade. Translating these novel pathobiological discoveries into therapies, prevention, or strategies to manage patients who are suspected to have or who have been diagnosed with bladder cancer is the ultimate goal. In particular, the chemoprevention of bladder cancer development is important, since urothelial cancer frequently recurs, even if the primary cancer is completely removed. The numerous alterations of both oncogenes and tumor suppressor genes that have been implicated in bladder carcinogenesis represent novel targets for therapy and prevention. In addition, knowledge about these genetic alterations will help provide a better understanding of the biological significance of preneoplastic lesions of bladder cancer. Animal models for investigating bladder cancer development and prevention can also be developed based on these alterations. This paper summarizes the results of recent preclinical and clinical chemoprevention studies and discusses screening for bladder cancer. PMID:21941546

  20. Bilateral ureteric obstruction secondary to renal papillary necrosis.

    PubMed

    Broadis, Emily; Barbour, Louise; O'Toole, Stuart; Fyfe, Alasdair; Flett, Martyn; Irwin, Greg; Ramage, Ian J

    2010-08-01

    A 2-year-old male presented to hospital with a 5-day history of vomiting and pyrexia. He was initially treated with non-steroidal medication as an anti-pyretic. Initial investigations demonstrated a raised urea and creatinine and he was treated with intravenous fluids. Within 24 h he became anuric with progressive renal insufficiency. Ultrasound scan demonstrated minimal bilateral hydronephrosis with debris in the lower pole calyces. The bladder was empty. Cystoscopy and retrograde contrast imaging revealed bilateral ureteric obstruction. Double J stents were inserted and his renal function returned to normal within 4 days. We believe the aetiology to be renal papillary necrosis and bilateral ureteric obstruction secondary to the administration of ibuprofen in association with dehydration.

  1. Obstructive acute renal failure related to amantadine intoxication.

    PubMed

    Nakai, Kentaro; Takeda, Kazuhito; Kimura, Hiroshi; Miura, Shuhei; Maeda, Atsuhiro

    2009-03-01

    We report the case of a 69-year-old woman with seizures and acute renal failure with hyperkalemia. She presented with bladder turgescence and hydronephrosis on admission and was diagnosed as obstructive acute renal failure. Urethral catheterization was performed after a single-session hemodialysis. It resulted in immediate improvement of renal function and consciousness, and subsequent disappearance of seizures. Improvement of serum creatinine level to 0.7 from 10.6 mg/dL was associated with a fall in blood level of amantadine hydrochloride from 4.40 to 0.47 microg/mL. Physicians should be aware of urinary retention in patients treated with amantadine as a first sign of intoxication that could lead if untreated to obstructive acute renal failure. And we recommend to check the overdose symptoms, even those with normal renal function, treated with amantadine.

  2. 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.

  3. Intravesical oxybutynin affects bladder permeability.

    PubMed

    Ersay, A; Demirtas, O C

    2001-01-01

    To investigate the effects of intravesical application of oxybutynin chloride on bladder permeability we designed an animal model. Female Guinea pigs were given 3 different test solutions: phosphate buffered saline (PBS), 50% acetone and 1.27 x 10(-2) M oxybutynin chloride solution. Then 99mTc-DTPA 45 microCi in 2 ml normal saline was instilled into the bladder lumen in each animals and allowed to dwell for 30 minutes. At the end of exposure time, the net count data in each 1 ml serum sample were corrected for radioactive decay and converted to the total percentage of administered dose. 99mTc-DTPA absorption percentages of both acetone and oxybutynin groups were significantly higher than that of PBS group (mean 3.2 +/- 2.9% p < 0.001). Intravesical oxybutynin application increases bladder permeability 5 times compared with PBS administration. This observation can also explain how rapid absorption of oxybutynin through the bladder into the systemic circulation occurs.

  4. 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.

  5. Ultrasonic lithotripsy of bladder stones.

    PubMed

    Cetin, S; Ozgür, S; Yazicioğlu, A; Unsal, K; Ilker, Y

    1988-01-01

    In the second half of 1985, 15 patients with 25 bladder stones were treated with Lutzeyer's Ultrasonic Lithotriptor. Of the patients 13 underwent additional operations, mostly transurethral resection of the prostate. The average duration of lithotripsy was 30.5 minutes. Some difficulties were experienced especially when drilling hard stones and as a complication late urethral bleeding occurred in one patient.

  6. 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.

  7. 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.

  8. 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

  9. Regulation of breathing and autonomic outflows by chemoreceptors.

    PubMed

    Guyenet, Patrice G

    2014-10-01

    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.

  10. [Obstructive uropathy in childhood].

    PubMed

    Balster, S; Schiborr, M; Brinkmann, O A; Hertle, L

    2005-08-01

    "Obstructive uropathy" is a generic term which combines different diseases in infants and childhood. Both the upper and lower urinary tract may be affected. Diseases of the urinary tract can cause an intrinsic obstruction. Sometimes tumours may cause a compression and as secondary effect an obstruction (extrinsic). Ultrasound is the key diagnostic tool and shows dilatation of the obstructed urinary tract. But for the functional exploration of babies and toddlers, renal scanning and X-ray examinations are necessary. These examinations lead to an exposure to radiation which necessitates careful indication. Some of the congenital diseases (for example ureteropelvic junction obstruction, megaureter) show a maturation without any intervention. So one has to decide whether to wait and see or to operate. A percutaneous nephrostomy or a DJ-catheter is not often used in the treatment of obstruction in general. These forms of drainage are more often used in the treatment of stones or of extrinsic obstruction. A pyelocutaneostomy or ureterocutaneostomy is a special surgical procedure in pediatric urology for transient drainage of the upper urinary tract (megaureter). The operation of a seriously ill new-born should be done in a centre for pediatric urology and pediatric nephrology. When the upper urinary tract is dilated, patients may need an antibiotic prophylaxis, because the dilatation of the upper urinary tract increases the risk of urinary tract infections (UTI). The indication for antibiotic prophylaxis should by guided by the criteria of the APN-Consensus Paper. Long-term follow-up is necessary and should comprise ultrasound, physical examination, controlling the blood pressure, urine analysis and blood tests. The aims of diagnostics, treatment and long-term follow-up are the preservation of renal function and to protect the children from UTI. This goal must be reached under conditions that are appropriate for children and their parents.

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

    PubMed

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

    2005-06-02

    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.

  12. How Stellar Feedback Simultaneously Regulates Star Formation and Drives Outflows

    NASA Astrophysics Data System (ADS)

    Hayward, Christopher C.

    2017-07-01

    Stellar-feedback-driven outflows are thought to be a crucial process in galaxy formation, but our physical understanding of them is still rudimentary. I will present an analytical model for how stellar feedback simultaneously regulates star formation and drives outflows. One interesting prediction of the model is that although stellar feedback can efficiently generate outflows in all galaxies at high redshift, it is unable to drive outflows in massive galaxies below z 1. This prediction agrees with the results of state-of-the-art cosmological zoom simulations that include explicit stellar feedback. This model, combined with the aforementioned simulations, suggests that high-redshift galaxies are highly turbulent, disordered and characterized by strong starbursts and subsequent violent outflows, and the suppression of outflows in massive galaxies at z 1 is crucial for the emergence of well-ordered, steadily star-forming disk galaxies.

  13. Atomic Hydrogen in a Galactic Center Outflow

    NASA Astrophysics Data System (ADS)

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

    2013-06-01

    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 ~14 km s-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 ~200 km s-1 in a Galactic wind.

  14. Interferometric Mapping of Perseus Outflows with MASSES

    NASA Astrophysics Data System (ADS)

    Stephens, Ian; Dunham, Michael; Myers, Philip C.; MASSES Team

    2017-01-01

    The MASSES (Mass Assembly of Stellar Systems and their Evolution with the SMA) survey, a Submillimeter Array (SMA) large-scale program, is mapping molecular lines and continuum emission about the 75 known Class 0/I sources in the Perseus Molecular Cloud. In this talk, I present some of the key results of this project, with a focus on the CO(2-1) maps of the molecular outflows. In particular, I investigate how protostars inherit their rotation axes from large-scale magnetic fields and filamentary structure.

  15. 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. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Right ventricular outflow tract aneurysm with thrombus

    PubMed Central

    Peer, Syed Murfad; Bhat, P.S. Seetharama; Furtado, Arul Dominic; Chikkatur, Raghavendra

    2012-01-01

    Right ventricular outflow tract (RVOT) aneurysm is a known complication of tetralogy of Fallot repair when a ventriculotomy is done. It leads to RV dysfunction and may require re-operation. We describe a rare instance of a patient who developed an RVOT aneurysm after trans-ventricular repair of tetralogy of Fallot, which was complicated with the formation of a thrombus in the aneurysm sac. The patient underwent re-operation with thrombectomy, excision of the RVOT aneurysm and pulmonary valve replacement. To the best of our knowledge, the occurrence of this combination and its implications have not been reported. PMID:22232231

  17. GGD 37: AN EXTREME PROTOSTELLAR OUTFLOW

    SciTech Connect

    Green, J. D.; Watson, D. M.; Forrest, W. J.; Kim, K. H.; Bergin, E.; Maret, S.; Melnick, G.; Tolls, V.; Sonnentrucker, P.; Sargent, B. A.; Raines, S. N.

    2011-01-01

    We present the first Spitzer-IRS spectral maps of the Herbig-Haro flow GGD 37 detected in lines of [Ne III], [O IV], [Ar III], and [Ne V]. The detection of extended [O IV] (55 eV) and some extended emission in [Ne V] (97 eV) indicates a shock temperature in excess of 100,000 K, in agreement with X-ray observations, and a shock speed in excess of 200 km s{sup -1}. The presence of an extended photoionization or collisional ionization region indicates that GGD 37 is a highly unusual protostellar outflow.

  18. 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