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Biomedical subjects

E P Arnold

Publications and source records attributed to E P Arnold.

At least 19 recordsLinked to original sources
PubMed2001

Tamsulosin in men with confirmed bladder outlet obstruction: a clinical and urodynamic analysis from a single centre in New Zealand.

OBJECTIVE: To evaluate the clinical and pressure-flow effects of tamsulosin 0.4 mg once daily in patients with lower urinary tract symptoms (LUTS) caused by benign prostatic obstruction (BPO), as documented by pressure-flow studies performed according to a standardized protocol in one centre. PATIENTS AND METHODS: A single-centre study was conducted with an open-label design comprising a 2-week, single-blind, placebo run-in period and a 12-week active treatment period with tamsulosin 0.4 mg once daily. Eligible patients were men (aged > or = 45 years) with LUTS (total International Prostate Symptom Score, IPSS, > or = 13) with a free-flow maximum urinary flow rate (Qmax) of > or = 4 mL/s for a voided volume of > or = 120 mL. After the 2-week placebo run-in period, only patients with BPO (i.e. in the obstructed zone of the Abrams-Griffiths, AG, nomogram) received active treatment with tamsulosin. The two primary efficacy variables were the change in detrusor pressure at maximum flow (PdetQmax) and the total IPSS, from baseline to endpoint. A standardized protocol was used for all pressure-flow studies. RESULTS: In all, 42 patients were enrolled into the 2-week placebo run-in period, after which 30 received active treatment with tamsulosin 0.4 mg once daily. All 12 patients (29%) who discontinued during the placebo run-in period failed to fulfil the pressure-flow entry criterion of confirmed obstruction. The 30 patients who received tamsulosin had a high mean PdetQmax (82.1 cm H2O) and high mean AG number (68.1) at baseline, as would be expected in obstructed patients. Tamsulosin produced a significant reduction in mean PdetQmax (-10.6 cm H2O or -13%; P = 0.005 vs baseline). The mean AG number decreased accordingly (-15.5 points or -23%; P < 0.001 vs baseline). The pressure-flow mean Qmax was increased by 2.5 mL/s (36%) from 7.0 mL/s at baseline (P = 0.002 vs baseline). Urodynamic improvements were accompanied by a good symptomatic response; the mean total IPSS was reduced by 6.7 points from a baseline value of 18.1 (-37%, P < 0.001 vs baseline). At the endpoint, 67% of patients had a clinically significant symptomatic response (defined as a decrease in total IPSS of > or = 25% from baseline). Twenty-six patients (87%) were either slightly improved (13) or were much improved (13) in the opinion of the investigator. Twelve patients with LUTS who were unobstructed after the 2-week placebo run-in (PdetQmax 44.1 cm H2O) received tamsulosin treatment outside of the study protocol. Although these patients had no decrease in mean PdetQmax, the magnitude of the symptomatic response (decrease in total IPSS -6.4 or -34%, P = 0.001) was comparable with that in unobstructed patients; the free-flow Qmax was also significantly improved. Possibly or probably drug-related adverse events were reported in nine patients; one discontinued tamsulosin treatment because of a serious adverse event. CONCLUSION: Tamsulosin 0.4 mg once daily can produce a significant decrease in detrusor pressure, increase in flow rate and a symptomatic improvement in patients with LUTS and confirmed obstruction. Patients with LUTS who are unobstructed and have a low initial detrusor pressure appear to have no improvement in detrusor pressure, but have similar clinical responses to those in obstructed patients. Pressure-flow studies can be reserved for those patients with LUTS who fail to respond to these agents and in whom further diagnosis and management is warranted.

Adrenergic alpha-Antagonists↗
PubMed2000

Total synthesis of (+/-)-cytisine.

[reaction:see text] The nicotine partial agonist cytisine was prepared in five steps featuring an "in situ" Stille or Suzuki biaryl pyridine coupling. Differentiation of the pyridyl rings was accomplished via selective benzylation and then reduction of a pyridinium ring. The penultimate diazabicyclo[3.3.1]nonane intermediate was obtained with high diastereoselectivity. A similar sequence has been employed for the synthesis of novel derivative 9-methoxycytisine.

Alkaloids↗
PubMed2000

Epidemiology and natural history of urinary incontinence.

This paper examines or current state of knowledge of the epidemiology of urinary incontinence. The population studied was community-dwelling non-institutionalized persons. The review includes discussion of the prevalence, incidence, natural history and presence of racial and ethnic differences in the epidemiology of urinary incontinence. We also review correlates and potential risk factors that have been revealed in epidemiological studies. Differences between epidemiological and clinical approaches to a health problem, help-seeking behavior and methodological issues for research are also discussed. We have reviewed a large number of completed studies in the field of urinary incontinence, and have emphasized high-quality and population-based studies. We also wished to present studies from a variety of countries. Because of the abundance of studies, only a small fraction can be presented here. Other studies may have equal standards and useful information, but lack of space precludes their inclusion.

Adult↗
PubMed2000

Monitoring of renal function in patients with spinal cord injury.

OBJECTIVE: To assess the sensitivity of serum creatinine level in detecting clinically important and early deterioration of renal function in patients with spinal cord injury (SCI), and to evaluate the optimal method of determining creatinine clearance in these patients. PATIENTS AND METHODS: The serum creatinine level of 36 patients (25 paraplegics and 11 quadriplegics) was evaluated and compared with the corresponding measured creatinine clearance rate. Correlations were also assessed between the creatinine clearance measured by 24-h endogenous clearance, single-shot 99mTc-labelled diethylenetriamine pentaacetic acid (99mTc-DTPA) clearance technique, and the Cockcroft-Gault formula, to test their validity. RESULTS: Of the 36 patients 11 (31%) had a measured creatinine clearance of < 100 mL/min (mean 84.8) and a corresponding normal serum creatinine level. Creatinine clearance calculated by the Cockcroft-Gault formula did not correlate well with that measured by the 24-h endogenous clearance (r = 0.426) and 99mTc-DTPA clearance (r = 0. 366), overestimating creatinine clearance in all but three patients. The mean (SD) difference between the creatinine clearance measured by the 24-h and DTPA clearance technique was 17.7 (16.5)% and the correlation between these techniques was good (r = 0.71). CONCLUSION: Serum creatinine level is not sensitive in detecting early deterioration of renal function in patients with SCI. The Cockcroft-Gault formula generally significantly overestimates the true creatinine clearance and is not recommended. The 24-h endogenous creatinine clearance measured on appropriately collected urine samples is an acceptable accurate and practical method of determining glomerular filtration rate in patients with SCI.

Adult↗
PubMed1998

Assessment and management of female urinary incontinence--a survey of current practice.

A survey of conference delegates attending the Urogynaecology Day at the 1997 Annual Scientific Meeting of the Royal Australasian College of Surgeons indicated that practitioners are inconsistent in their approach to the use of preoperative urodynamics evaluation for women with stress incontinence and disagree about the significance of the low pressure urethra.

Female↗
PubMed1997

Desmopressin for nocturnal enuresis: urinary osmolality and response.

OBJECTIVE: To measure the effect of intranasal desmopressin (l-deamino 8-D-arginine vasopressin, DDAVP) on urine osmolality in a group of patients with persistent primary enuresis, and to determine whether changes in osmolality can the predict response to treatment. PATIENTS AND METHODS: Thirty-seven patients with persistent primary nocturnal enuresis were entered into a double-blind placebo-controlled crossover trial of 20 micrograms intranasal DDAVP spray. Morning urinary osmolality was measured on two occasions during each phase of treatment and the clinical response recorded in a diary. RESULTS: Thirty-one patients (22 males and nine females) were evaluable at the end of the trial period. A good clinical response, defined as enuresis on two nights or fewer each week, occurred in 12 of 31 (39%) patients, but complete continence was attained in only two. The response was better in older patients and in those with less frequent enuresis. The mean and peak urinary osmolality of the morning urine samples were higher while on treatment with DDAVP compared with placebo, but this difference was not statistically significant and the response did not predict a good clinical outcome in improving the enuresis. CONCLUSIONS: Treatment with DDAVP can produce a socially acceptable level of dryness in some patients with refractory nocturnal enuresis. However, the early morning urinary osmolality, as a reflection of changes in nocturnal osmolality, was not useful in distinguishing this group or in selecting those who will respond to treatment.

Administration, Intranasal↗
PubMed1995

Management of spinal cord injured patients by indwelling suprapubic catheterization.

PURPOSE: We review the urological complications in spinal cord injury patients treated with suprapubic catheterization. MATERIALS AND METHODS: Suprapubic catheterization was used in 44 spinal cord injury patients. Followup ranged from 12 to 150 months (mean 58). The catheters were irrigated weekly and changed every 2 weeks. Patients were followed annually with urodynamic studies and ultrasound. RESULTS: No patient had renal deterioration, vesicoureteral reflux or bladder carcinoma. The incidences of incontinence, urinary tract infections and calculi were acceptable. CONCLUSIONS: Suprapubic catheterization is an effective and safe alternative form of bladder management in select patients with spinal cord injury.

Adolescent↗
PubMed1994

Clam cystoplasty for the overactive bladder: a review of 23 cases.

A clam enterocystoplasty was performed for refractory urge incontinence due to either idiopathic instability (13 patients) or neuropathic hyperreflexia (10 patients). Twelve patients became dry and appliance free. Of the remaining 11 wet patients, seven developed low pressure reservoirs, of whom five had stress incontinence and two had overflow incontinence. The other four patients had persistent symptomatic involuntary phasic contractions and ongoing urge incontinence. The magnitude of the surgery and the voiding dysfunction associated with the relative lack of motivation of elderly patients made the operation less successful and more hazardous in those over the age of 65. Successful outcome could be improved by careful patient selection and by performing an antistress incontinence procedure, such as implantation of an artificial urinary sphincter cuff or a cystourethropexy, where there is associated bladder outlet incompetence.

Adolescent↗
PubMed1994

Carcinoma in situ of the testis followed by an overt malignant teratoma of the testis within 12 months.

A case of bilateral metachronous testicular non-seminomatous germ cell tumour (NSGCT) is presented. The second tumour was preceded by carcinoma in situ, diagnosed at the time of the first orchidectomy. The patient was placed under active surveillance and 1 year later the second testis tumour developed. A second orchidectomy was performed and testosterone replacement begun. Carcinoma in situ of the testis is discussed.

Adult↗
PubMed1994

Sexual function after pelvic surgery in women.

To assess the prevalence of sexual dysfunction after pelvic floor surgery for nonmalignant conditions, a retrospective survey was performed. Replies from a postal survey were received from 66 of the 200 women canvassed. Dyspareunia developed in 10 patients who had never had it before the operation, however of those who had it preoperatively the pain stopped completely in 12 of 23. Reduced libido was noted in 16 of 54 (29%), reduced lubrication in 21 (38%), and reduced genital sensation in 10 (18%). Lack of information about the potential effects of surgery on sexual function was identified as a major deficit and of considerable concern to 35 of the 66 women. Sexual function after surgery should be evaluated more intensively, and the subject discussed openly before any contemplated operation.

Adult↗
PubMed1988

Reproduction study of toxaphene in the rat.

The purpose of the present study was to investigate in rats the reproductive effects of toxaphene, an insecticidal mixture which has been identified as a pollutant in the Great Lakes ecosystem. Groups of 30 female and 15 male weanling rats were given toxaphene in the diets at 0, 4.0, 20, 100 or 500 ppm in a 1 generation 2 litter reproduction study. Toxaphene treatment at the levels studied had no effects on the litter size, pup weight, fertility, or gestation and survival indices. Toxic effects in the parental rats included depressed weight gain, elevated serum cholesterol, and increased liver and kidney weight and hepatic microsomal enzyme activities. Most of these effects were associated only with 500 ppm toxaphene treatment. Treatment-related histological changes in the liver, thyroid and kidney of adult rats were observed at levels as low as 20 ppm. Based on the data presented, the no observable adverse effect dose of toxaphene was considered to be 4.0 ppm in the diet (0.29-0.38 mg/kg b.w./day depending on the amount of dietary intake).

Aminopyrine N-Demethylase↗
PubMed1988

Clinical significance of ureteric diameter on intravenous urography after spinal cord injury.

The ureteric diameter on IVU was compared with the MCU findings of reflux or lower urinary tract dysfunction in a group of patients followed up after spinal cord injury. A wide ureter was associated with reflux in 20%, but 8 normal sized ureters on IVU also refluxed--5 of them to a significant degree. In the non-refluxing group, wide ureters were noted more often in patients whose bladder pressures were high and wildly fluctuating than in those with normal bladder pressures. Similarly, the incidence of reflux was higher in patients with high bladder pressures and wild fluctuations of bladder pressure than in those with normal pressures. While a wide ureter on IVU should arouse suspicion that reflux or lower urinary tract dysfunction might be present, these conditions are not necessarily excluded by the finding of a ureter of normal size.

Humans↗
PubMed1986

Sacral anterior root stimulation of the bladder in paraplegics.

A Brindley-Finetech sacral anterior root stimulator has been placed intradurally in the spinal canal around the S2, 3, 4 nerve roots in six paraplegics at the Burwood Spinal Injuries Unit, Christchurch, New Zealand. The apparatus developed by Professor G. S. Brindley and the Medical Research Council in London, UK, has proved very useful in driving micturition, in achieving a dry device-free interval between electromicturitions, in reducing the incidence of urinary tract infections, and in some males in achieving a sustained erection. The clinical results are presented with a urodynamic analysis of the outcome.

Electric Stimulation Therapy↗
PubMed1986

Trophoblastic metaplasia in urothelial carcinoma of the bladder.

Trophoblastic differentiation in bladder carcinoma is reported in four patients. Plasma gonadotrophin (beta subunit of HCG), measured in three patients, was elevated. In one patient treated with cisplatin, vinblastine and bleomycin, the beta HCG level fell significantly but progression of malignant disease was not arrested.

Adult↗