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Biomedical subjects

J K Light

Publications and source records attributed to J K Light.

At least 37 records · Page 2Linked to original sources
PubMed1991

Continence mechanisms following continent urinary diversion and orthotopic bladder replacement.

It is obvious that significant advances have been made in reconstruction of the lower urinary tract following radical pelvic surgery. In contrast to the standard ileal loop, patients no have an option to void per urethra, have social continence and avoid self-intermittent catheterization in the presence of an abdominal stoma. Further refinements in construction of the continence mechanism will undoubtedly occur in the future.

Animals↗
PubMed1991

Candida pyelonephritis complicating traumatic C5 quadriplegia: diagnosis and management.

We present the first reported case of Candida pyelonephritis in a spinal cord injured patient. In addition to multiple courses of empiric antibiotics, the neurogenic bladder and alteration in cell-mediated immunity found in spinal cord injured patients may have increased this patient's susceptibility to fungal disease. A 50-year-old patient with C5 motor functional quadriplegia developed Candid albicans pyelonephritis while undergoing rehabilitation. The patient had several surgical procedures and multiple courses of antibiotic therapy during acute hospitalization. He continued to have a hectic fever curve, leukocytosis with increased band forms, lethargy, and progressive uremia during rehabilitation. Successful investigation of the patient's condition included assessment of serologic tests for Candida precipitin antigen; multiple blood and urine cultures; exclusion of other causes of hectic fever; abdominal computerized tomogram, which revealed a left kidney hypodensity with irregular margins; and a retrograde pyelogram, which demonstrated multiple renal pelvic-filling defects. Cystoscopically placed ureteral stents, which relieved the genitourinary obstruction, drained gross pus from which Candida albicans was cultured; the patient was treated with amphotericin B and showed clinical improvement. Pathogenesis, presentation, diagnosis, and treatment of Candida pyelonephritis are reviewed.

Algorithms↗
PubMed1990

Total bladder replacement in the male and female using the ileocolonic segment (LeBag).

A group of 11 patients, 2 female and 9 male, underwent total bladder replacement using the ileocolonic segment (LeBag technique) with anastomosis of the bowel to the urethra. The diagnosis was invasive bladder cancer in 10 patients and severe intractable interstitial cystitis in 1. The surgical technique in the male patients was modified to simplify the procedure. The 2 female patients underwent insertion of an artificial sphincter around the bowel segment for a continence mechanism. One patient died 6 weeks post-operatively from a severe coagulopathy. Five of the 9 male patients are continent day and night, relying on their own residual sphincter mechanism, but the remaining 4 required insertion of the artificial urinary sphincter to achieve social continence. The surviving female patient is totally continent. All patients have voiding intervals of 4 to 6 h during the day and are thus continent both day and night, but in some cases the artificial sphincter was necessary to achieve this. Loss of the normal bladder-sphincter reflexes following cystectomy may account for the high incidence of nocturnal incontinence observed in most series. Total bladder replacement is now possible in both male and female patients, thus avoiding an abdominal stoma.

Adult↗
PubMed1989

Management of urinary incontinence after prostatectomy with the artificial urinary sphincter.

A total of 37 patients underwent implantation of the artificial urinary sphincter for urinary incontinence after prostatectomy. Followup was 4 to 96 months, with a mean of 37 months. Social continence was achieved in 94.5 per cent of the patients. No abnormality of detrusor function was found in any patient. Prior pelvic irradiation appears to increase the risk of cuff erosion. Routine nocturnal deactivation of the device together with primary deactivation is recommended to decrease the incidence of cuff erosion in this patient group.

Aged↗
PubMed1989

Adrenergic innervation of the striated muscle of the intrinsic external urethral sphincter from patients with lower motor spinal cord lesion.

The adrenergic innervation of smooth and striated muscle components of the intrinsic external urethral sphincter from patients with suprasacral lesions and detrusor-sphincter dyssynergia has been described previously, when no adrenergic nerves were found associated with striated muscle fibers. In our study the intrinsic external urethral sphincter from patients with lower motor neuron lesions and detrusor areflexia was studied histochemically using the glyoxylic acid method to visualize catecholamines. Varicose adrenergic nerves were demonstrated in the smooth muscle. Adrenergic nerve fibers also were found along the edge of individual striated muscle fibers as well as around striated muscle bundles. Blood vessels in both regions of the urethral sphincter were innervated by adrenergic nerves. We conclude that in patients with lower motor neuron lesions and detrusor areflexia there is a substantial invasion by adrenergic nerve fibers in relation to smooth and striated muscle in the urethra, although the function of the nerve fibers is not known.

Adrenergic Fibers↗
PubMed1989

Long-term clinical results using the artificial urinary sphincter around bowel.

Four patients are presented in whom bowel was used to reconstruct a bladder. As a sphincteric mechanism was absent in all 4, the cuff from the artificial urinary sphincter was placed around the bowel to provide continence. This allowed for "normal" urination. The longest follow-up period was 11 years and the shortest 1.5 years. Both clinical and experimental data show that bowel will tolerate compression from the artificial urinary sphincter provided infection does not supervene and the pressure does not exceed 80 cm of water.

Child↗
PubMed1988

Male urinary incontinence. What do you do?

Urinary incontinence is a common ailment in men. Treatment, although readily available, is often overlooked. An understanding of the anatomy and physiology of the continence mechanism aids in proper diagnostic evaluation. Determination of the cause involves a complete history and physical examination, urodynamic studies, and radiologic tests. Treatment of incontinence is based on the specific cause. In general, conservative management with pharmacologic manipulation is the primary form of treatment. Surgical intervention, when indicated, offers a high success rate, particularly since the advent of the artificial urinary sphincter.

Humans↗
PubMed1988

Intramural ganglia in the human urethra.

The urethras from five patients with a thoracic or cervical spinal cord lesion and one patient with carcinoma of the bladder were studied immunohistochemically for neuropeptide Y and vasoactive intestinal polypeptide. Autonomic ganglia, containing two to 21 nerve cell bodies, were found in the smooth and striated muscle regions of the intrinsic external urethral sphincter; they were present rarely in the distal urethra and were absent from the prostatic urethra. Neuropeptide Y immunoreactivity was observed in some of the nerve cell bodies (diameter 25 to 50 microns). Vasoactive intestinal polypeptide immunoreactivity was observed in small cells (diameter 15 to 25 microns.) in the urethral smooth muscle and in the walls of blood vessels that resembled small intensely fluorescent cells but may be nerve cell bodies. Both neuropeptide Y- and vasoactive intestinal polypeptide-immunoreactive nerve fibres were found in the smooth muscle and around blood vessels in the urethra of all patients. Both types of peptide-containing nerves were found associated with striated muscle of the intrinsic external urethral sphincter in patients with spinal cord injury, but only vasoactive intestinal polypeptide-immunoreactive nerves were found in the patient with carcinoma of the bladder in this region. The functions of the autonomic ganglia and vasoactive intestinal polypeptide- and neuropeptide Y-immunoreactive nerves in the human urethra remain to be elucidated.

Fluorescent Antibody Technique↗
PubMed1988

Spinal cord lesions at different levels affect either the adrenergic or vasoactive intestinal polypeptide-immunoreactive nerves in the human urethra.

The urethras from 1 patient with cervical (C1-2) and 2 patients with thoracic (T10) spinal cord lesions were studied histochemically and immunohistochemically for adrenergic and vasoactive intestinal polypeptide-immunoreactive nerves. Dense vasoactive intestinal polypeptide-immunoreactive but not adrenergic nerves were found in the urethral smooth muscle, around the blood vessels and at the base of the mucosa in the patients with thoracic lesions. In contrast, adrenergic but not vasoactive intestinal polypeptide-immunoreactive nerves were found associated with the smooth muscle of the urethra and around the blood vessels in the patient with a cervical lesion. In patients with cervical or thoracic lesions neither adrenergic nor vasoactive intestinal polypeptide-immunoreactive nerves were found around striated muscle fibers of the intrinsic external urethral sphincter. The results are discussed in relation to the possible function of these nerves in the urethra of patients with autonomic dysreflexia and detrusor-sphincter dyssynergia.

Adult↗
PubMed1987

Neuropeptide Y- and vasoactive intestinal polypeptide-containing nerves in the intrinsic external urethral sphincter in the areflexic bladder compared to detrusor-sphincter dyssynergia in patients with spinal cord injury.

Specimens of urethra were obtained from patients with cervical and thoracic spinal cord lesion with detrusor-sphincter dyssynergia and from patients with lower motor neurone lesion with detrusor areflexia, undergoing transurethral sphincterotomy. Neuropeptide Y (NPY) and vasoactive intestinal polypeptide (VIP) in nerves associated with both the smooth and striated muscle components of the urethral sphincter were studied immunohistochemically and by immunoassay. In patients with detrusor-sphincter dyssynergia following cervical and thoracic spinal cord injury, NPY- and VIP-immunoreactive varicose nerve fibres were seen in both the smooth and striated muscle components of the urethral sphincter. In the smooth muscle, NPY- and VIP-immunoreactive nerves did not appear to have any particular orientation, but in the striated muscle region they were found to run along the length of individual muscle fibres. In patients with detrusor areflexia following lower motor neurone lesion, while the pattern, density and fluorescence intensity of NPY- and VIP-immunoreactive nerves in the smooth muscle of the sphincter mechanism appeared the same as seen in patients with detrusor-sphincter dyssynergia, there was a marked increase in the density of these nerves in the striated muscle region of the sphincter mechanism. Quantitation of the peptides by immunoassay was consistent with the histochemical findings, with significantly higher levels of both NPY and VIP in the striated muscle of patients with lower motor neurone lesion, compared to those with cervical and thoracic spinal cord lesion, p = 0.04. NPY and VIP levels in urethral smooth muscle were in the same range in lower motor neurone lesion patients and cervical and thoracic spinal cord lesion patients. We conclude that there are increased NPY- and VIP-containing fibres in striated muscle of the intrinsic external urethral sphincter in patients with areflexic bladder compared with those with detrusor-sphincter dyssynergia.

Adult↗
PubMed1987

Predictive criteria for failed sphincterotomy in spinal cord injury patients.

Nine patients with chronic high spinal cord injury who failed sphincterotomy secondary to detrusor hypocontractility underwent neurourological evaluation. Testing revealed an abnormality involving the sensory limb of the somatic sacral reflex arc (abnormal R wave) or at the level of the spinal interneuron pool (abnormal or absent S wave). This study strongly suggests that the sensory input from the bladder to the spinal cord, together with alteration in the sensory motor integration that occurs at the level of the interneuron pool, is important in influencing the characteristics of the detrusor contraction following high spinal cord injury. Predictive criteria for failed sphincterotomy are a slow increase to maximum intravesical pressure before voiding and abnormal lumbosacral sensory evoked potentials.

Adolescent↗
PubMed1987

A clinical syndrome of rostral and caudal spinal injury: neurological, neurophysiological and urodynamic evidence for occult sacral lesion.

Patients with spinal cord injury show upper motor neuron dysfunction below the level of the lesion. Some patients with cervical and high thoracic injuries show unexpected lower leg atrophy and ankle jerk abnormalities together with persistence of urinary retention. Clinical, neurophysiological and urodynamic findings in 130 patients with cervical and thoracic injuries showed that 18 patients had additional lumbosacral dysfunction. Three patients had radiological findings demonstrating a second lesion of the lower spine. The remaining 15 patients, however, did not have any obvious bony lesion to account for the lumbosacral dysfunction. Atypical neurological findings, abnormal neurophysiological testing and aberrant detrusor behaviour were the essence of the occult lumbosacral dysfunction in cervical and thoracic spinal cord injury patients. Recognition of the presence of a double lesion was important for care of the neuropathic bladder and pain in addition to understanding the unexpected clinical signs.

Adult↗
PubMed1986

Le bag: total replacement of the bladder using an ileocolonic pouch.

Creation of an ileocolonic pouch for total bladder replacement is described in 4 patients, resulting in a highly compliant, low pressure bladder. Previous experience with bowel segments for bladder augmentation and replacement have been plagued by unpredictable bowel contractions with urinary incontinence as well as potential for renal damage. A reliable method to achieve a highly compliant, low pressure system requires disruption of directional bowel peristalsis, which this technique has succeeded in achieving. The operative technique, bowel dynamics, renal status and clinical results are described. The ileocolonic pouch offers a low pressure reservoir for total replacement of the bladder in selected patients.

Colon↗
PubMed1986

Alteration in detrusor behavior and the effect on renal function following insertion of the artificial urinary sphincter.

The neuropathic bladder may exhibit altered function following insertion of the artificial urinary sphincter. Detrusor hyperreflexia worsened in 7 patients following implantation of the device. However, the hyperreflexia may improve spontaneously once healing is complete. Detrusor areflexia with functional diminished compliance may remain unchanged (3 patients) or show an increased graphic gradient (10) postoperatively. These changes may result in hydronephrosis (3 patients) or urinary incontinence depending on the temporal relationship between the cuff pressure and the intravesical filling pressure. Possible explanations for the postoperative deterioration in the compliance are activation of the short neuron system, an increase in the alpha-adrenergic response or sensory receptor adaptation coupled with a severe partial lesion of the long neuron system. Because of the propensity for these changes to occur long-term followup is necessary.

Adolescent↗
PubMed1986

Adrenergic and cholinergic innervation of the smooth and striated muscle components of the urethra from patients with spinal cord injury.

The adrenergic and cholinergic innervation of the smooth and striated muscle components of the urethra from spinal cord injury patients with detrusor sphincter dyssynergia were investigated neurochemically and histochemically. Catecholamine fluorescence histochemistry provided no evidence for the presence of adrenergic nerves associated with the skeletal muscle. The noradrenaline content of this region probably reflects the endogenous levels in adrenergic nerves associated with the blood vessels supplying the skeletal muscle. Choline acetyltransferase activity in the skeletal muscle was significantly lower in patients with cervical lesions than in those with thoracic lesions (p less than 0.01). The noradrenaline content of the smooth muscle was significantly lower in cervical lesions than in thoracic lesions in both the mid (p less than 0.02) and the distal (p less than 0.001) regions of the urethra. The proximal region revealed similar noradrenaline levels in both groups of spinal cord injury patients. The results are discussed in relation to the role of the autonomic nervous system in the control of voiding and to the presence of increased sympathetic outflow in patients with spinal cord lesions at higher levels.

Adolescent↗
PubMed1986

Radical cystectomy with preservation of sexual and urinary function. Use of the ileocolonic pouch ("Le Bag").

Current surgical technique allows radical cystectomy to be performed with preservation of both sexual and urinary function. An ileocolonic pouch (Le Bag), is created to replace the bladder, with anastomosis directly to the urethra. Continence depends on the inherent function of the residual sphincter mechanism. The ileocolonic pouch results in a highly compliant, low-pressure reservoir with a reliable antireflux ureteric implantation.

Colon↗