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C R Chapple

Publications and source records attributed to C R Chapple.

At least 145 records · Page 8Linked to original sources
PubMed1990

What is the clinical significance of urethroprostatic reflux as a radiological finding during videocystourethrography in neurologically normal patients?

The video records of 264 males referred for videocystometry were reviewed retrospectively for evidence of urethroprostatic reflux. This was found in 11% of the cases with three distinct patterns; during bladder filling (27%); during voiding (50%), and during the 'stop test' (23%). All cases with filling reflux were unstable. Reflux at the time of the stop test was usually associated with prostatic or bladder neck obstruction. Voiding reflux occurred in a similar group of patients but there was often a clinical history of the previous surgical relief of obstruction or documented urinary infections. Recognition of this sign suggests the transmission of high pressures to the prostatic urethra and contrary to previous work is uncommonly associated with a history of lower urinary tract pain in cases where it may otherwise go unexplained.

Adult↗
PubMed1990

The ultrasound cystodynamogram--a new radiological technique.

Voiding dysfunction may be assessed using the intravenous urodynamogram (IVUD) or combined with pressure studies in the videocystometrogram (VCMG). However, VCMG requires bladder catheterization and voiding in public which often leads to inhibition of sphincter relaxation. For this reason the urinary flow rate measurement performed in private is more representative of the true voiding pattern. The ultrasound cystodynamogram (USCD) evaluates the bladder capacity, mean and maximum flow rates, flow pattern and post-micturition residual. The diagnostic capability of USCD was studied in 116 consecutive cases 46 of whom had also had VCMG. Comparison of the data obtained using both techniques revealed no significant difference. USCD has proved to be accurate, safe and reproducible and is of particular value in patient follow-up.

Adolescent↗
PubMed1989

Autoradiographic analysis of alpha-adrenoceptors and muscarinic cholinergic receptors in the hyperplastic human prostate.

Radioligand receptor binding and autoradiography were used to characterize, localize and compare alpha-1 and alpha-2 adrenoceptors and muscarinic cholinergic receptor populations in human benign prostatic hyperplastic tissue. The binding of selective alpha-1 and alpha-2 ligands, [3H]-prazosin and [3H]-UK 14,304, to homogenates of human central and peripheral prostate was saturable and of high affinity. Scatchard analysis produced an equilibrium dissociation constant (KD) of 0.51 +/- 0.10 nM for alpha-1 adrenoceptors, and 2.34 +/- 0.40 nM for alpha-2 adrenoceptors. The mean densities, Bmax, of alpha-1 and alpha-2 adrenoceptors identified in the human adenomatous prostate were 65.9 +/- 12.9 and 36.1 +/- 7.0 fmoles/mg. protein respectively. Receptor autoradiography was used to examine the distribution of muscarinic cholinergic receptors [( 3H]-QNB), alpha-1 adrenoceptors [( 3H]-prazosin]), and alpha-2 adrenoceptors [( 3H]-rauwolscine) on consecutive sections of benign hyperplastic prostatic tissue. Although both subtypes of adrenoceptor were seen in the stromal component of the hyperplastic prostate, there was a substantial predominance of alpha-1 adrenoceptors. A densitometric computer-assisted analysis was performed on the autoradiographic slides to determine the mean ratio of specific alpha-1: alpha-2 adrenoceptors in the stromal compartment of the hyperplastic tissue. The ratio, expressed as % grain occupancy/unit area, was 3.9 +/- 0.75, which is in agreement with a functional alpha-1 adrenoceptor predominance shown in previous studies. Although sparsely distributed in the stroma, a dense alpha-2 adrenoceptor population was seen in association with blood vessels, and in close proximity to the base of some of the [3H]-QNB-labelled prostatic glandular epithelial cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Bonney's blue cystitis: a warning.

The instillation of diluted Bonney's blue into the bladder during gynaecological operations has been quite common practice over the last 50 years. Bonney's blue is composed of a 1:1 mixture of brilliant green and crystal violet dissolved in ethanol (90%) or industrial methylated spirit. Before insertion into the bladder this solution must be diluted with water to a 0.5% solution. Failure to do this will result in a severe inflammatory reaction within the bladder. The degree of resultant damage depends upon the duration of exposure. Persistent pain is a feature of this condition, although the other symptoms (frequency and urgency) may settle in time. Two cases of chemical cystitis resulting from the use of undiluted Bonney's blue are described to illustrate the possible consequences. Both patients were awarded 6-figure sums as compensation.

Administration, Intravesical↗
PubMed1989

A new stent for the treatment of urethral strictures. Preliminary report.

We describe a new urethral stent which was implanted into 12 patients with urethral strictures. The stent is woven in the form of a tubular mesh from fine stainless steel wire and is self-expanding when released from its small diameter delivery catheter. All patients have been treated successfully, with a good calibre urethra visible on urethrography and direct endoscopy and with improved urine flow rates. The mean follow-up of these patients was 7 months (range 2-13). Urethroscopy demonstrated complete epithelial covering of the implant in 4 to 6 months. Although the follow-up period was short, it seems that this simple technique may offer a lasting treatment for many urethral strictures. A longer follow-up will be necessary to exclude late complications.

Adult↗
PubMed1989

Contemporary flow meters: an assessment of their accuracy and reliability.

The accuracy, reliability and cost effectiveness of 5 currently marketed flow meters have been assessed. The mechanics of each meter is briefly described in relation to its accuracy and robustness. The merits and faults of the meters are discussed and the important features of flow measurements that need to be taken into account when making diagnostic interpretations are emphasised.

Costs and Cost Analysis↗
PubMed1989

Characterisation of human prostatic adrenoceptors using pharmacology receptor binding and localisation.

Benign prostatic enlargement is a common cause of bladder outlet obstruction. Recent work has demonstrated the important role played by the sympathetic nervous system in the control of prostatic muscle tone. Although isometric muscle strip studies and clinical trials have highlighted the influence of alpha-1 adrenoceptors, radioisotope ligand binding studies have demonstrated a relatively increased density of alpha-2 adrenoceptors in the muscle within prostatic tissue, the significance of which is as yet unexplained. Forty patients entered a study using pharmacological muscle strip experiments, radioligand binding assays and receptor autoradiography. Pharmacological data from these studies confirmed that contraction of prostatic muscle is mediated predominantly by alpha-1 adrenoceptor stimulation, with no evidence of significant alpha-2 adrenoceptor or cholinergic mediated effects. Radioligand binding studies confirmed that there is a higher concentration of alpha-1 binding sites as contrasted to alpha-2 within normal prostate, but that this relationship approaches equity in adenomatous prostate. Autoradiographic localisation demonstrated that alpha-1 adrenoceptor binding is predominant within prostatic stroma with only a small component of alpha-2 adrenoceptors in this compartment. This comprehensive study supports the suggestion that prostatic muscular contraction is controlled by the influence of the sympathetic nervous system acting via alpha-1 adrenoceptors. These findings support the therapeutic use of specific alpha-1 adrenoceptor blockade in the management of benign prostatic hyperplasia.

Adult↗
PubMed1989

Asymptomatic bladder neck incompetence in nulliparous females.

This study investigated 29 nulliparous women using the technique of transvaginal ultrasound to assess whether their bladder necks were open or closed at rest. The patients comprised 2 groups: 4 reported occasional episodes of stress incontinence, all of whom had closed bladder necks; the remaining 25 patients were totally asymptomatic. Overall a 21% incidence of an open bladder neck was recorded. It is likely that the true incidence of open bladder necks in young nulliparous women is higher than this, since none of these patients had troublesome stress incontinence. Since women with open bladder necks are more likely to develop stress incontinence if the integrity of the distal sphincter mechanism is compromised by neural damage, antenatal recognition of this problem should provide a contraindication to traumatic vaginal delivery and may in the future reduce the incidence of symptomatic stress incontinence in the population.

Adult↗
PubMed1988

Abnormal electromyographic activity of the urethral sphincter, voiding dysfunction, and polycystic ovaries: a new syndrome?

A potential association between abnormal electromyographic activity--that is, decelerating bursts and complex repetitive discharges--of the urethral sphincter and difficulty in voiding was examined in 57 women with urinary retention. Abnormal electromyographic activity was found in 33. Ultrasonography of the ovaries in 22 of the 33 women showed that 14 had polycystic ovaries. Of the other eight women, two had had oophorectomies, one had shrunken ovaries and ovarian failure, and one had previously undergone oophorectomy and the other ovary could not be seen; in one neither ovary could be seen, and three had ovaries of normal appearance, although two of these women were taking the contraceptive pill. Thirteen of the group had endocrine symptoms and signs characteristic of the polycystic ovary syndrome. Videocystometrography in 17 of the women who were examined by ultrasonography showed low flow rates and high residual volumes of urine after micturition in 12 women who could void, the other five having chronic urinary retention. A speculative hypothesis for the observed association of impaired voiding, abnormal electromyographic activity of the urinary sphincter, and polycystic ovaries is advanced, based on the relative progesterone deficiency that characterises the polycystic ovary syndrome. Progesterone stabilises membranes, and its depletion might permit ephaptic transmission of impulses between muscle fibres in the muscle of the urethral sphincter, giving rise to the abnormal electromyographic activity. This may impair relaxation of the sphincter, resulting in low flow rates of urine, incomplete emptying of the bladder, and, finally, urinary retention.

Adult↗
PubMed1988

Bonney's blue.

Explore the source record for details and available documents.

Administration, Intravesical↗
PubMed1988

A new treatment for urethral strictures.

A urethral stent, originally developed for endovascular use, was implanted into eight patients with urethral strictures after experimental studies in the canine urethra. The stent is woven in the form of a tubular mesh from surgical grade stainless steel wire and is self-expanding when released from its small-diameter delivery catheter. At follow-up 6 months to 1 year postoperatively (mean 8 months) all had a good calibre urethra. Urethroscopy showed complete epithelial covering of the implant at 4-6 months.

Adult↗
PubMed1988

Hyperparathyroidism after neck irradiation.

A retrospective review of 1550 cases of hyperparathyroidism (HPT) treated surgically over a 30-year period reveals a past history of exposure to neck irradiation in 10 cases (0.7 per cent). The indication for radiotherapy was benign disease in nine and papillary thyroid carcinoma in one case. The mean interval between radiation exposure and the detection of HPT was 32 years (range 3-63 years). Patients treated with radioactive iodine alone developed HPT after a mean of 5 years while the interval for those treated with external beam therapy alone was a mean of 44 years. The parathyroid histology was adenoma in six cases, carcinoma in three cases and nodular hyperplasia in one case. All patients had coincident benign thyroid disease apart from one that had previously had papillary carcinoma and another with follicular carcinoma. Neck irradiation has been shown to confer an increased risk of HPT due to parathyroid adenoma and carcinoma. Radiotherapy for benign disease has generally been abandoned and these cases demonstrate a further contra-indication for the use of neck irradiation.

Adult↗
PubMed1988

Gastric adenocarcinoma associated with adenomyoma of the stomach.

We report a case of gastric adenomyoma contiguous with adenocarcinoma of the stomach. Although a similar association is well recognized in the duodenum, we believe this to be the first documented case in the stomach. We review the literature on adenomyomata and discuss the implications of this finding. It would appear that glandular and cystic intramural lesions of the stomach are a heterogeneous group, and while there is a well established association between gastric carcinoma and gastritis cystica profunda, the same does not apply to gastric adenomyoma.

Adenocarcinoma↗