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Biomedical subjects

J R Woodside

Publications and source records attributed to J R Woodside.

At least 55 records · Page 3Linked to original sources
PubMed1982

Stress urinary incontinence in men.

Stress urinary incontinence is a distinctly unusual finding in men who have had no prior pelvic or urologic surgery. Seven men with stress urinary incontinence underwent urodynamic evaluation. All patients had urethral smooth muscle dysfunction manifested by decreased urethral pressure and the presence of radiographic contrast material in the proximal urethra. One patient with adenocarcinoma of the prostate had had a prior prostatectomy and subsequently had metastases with cauda equina compression. One patient had destruction of the pelvic plexus from metastastic choriocarcinoma. All other patients had neurologic lesions involving spinal roots L1 and/or L2, resulting in interference with adrenergic innervation of the proximal urethra. Thorough neurologic evaluation should be obtained in a man with stress urinary incontinence who has had no prior operation that could damage the pelvic plexus or urethral sphincter mechanisms.

Adolescent↗
PubMed1982

The Manx cat as an animal model for neurogenic vesical dysfunction associated with myelodysplasia: a preliminary report.

The Manx cat breeds consistently for spinal dysraphism (myelodysplasia) and has spinal cord neuropathologic abnormalities similar to those of myelodysplastic humans. The results of detailed urodynamic and histochemical evaluation of 1 Manx kitten and limited anatomic study of another Manx kitten are described. Urodynamic evaluation revealed significant abnormalities of vesicourethral function: detrusor areflexia, autonomous pressure response to bladder filling, a dysfunctional proximal urethra and poor quality pelvic floor electromyographic activity. Of particular interest, catecholaminergic histochemical studies of the bladder and urethra demonstrated a complete absence of adrenergic fibers, even in the trigone area where they are reported to be abundant. This finding correlated with the urodynamic dysfunction of the proximal urethra. Cholinergic histochemical studies were normal. Examination of the spinal cord revealed moderate hydromyelia throughout the entire length of the cord. The similarities of normal vesicourethral function in man and the cat and our preliminary findings of vesicourethral dysfunction in the Manx cat suggest that this animal may be a particularly valuable model for further research.

Adrenergic Fibers↗
PubMed1982

Pubovaginal sling procedure for the management of urinary incontinence in a myelodysplastic girl.

Urinary incontinence is a formidable social handicap in many children with myelodysplasia. Girls in whom pharmacologic therapy and intermittent catheterization fail to alleviate incontinence present particularly difficult management problems. Permanent catheter drainage of the bladder or supravesical urinary diversion frequently has been used solely for control of incontinence. More recently, the artificial sphincter has been used in selected patients. We herein describe the use of a pubovaginal sling to augment bladder outlet resistance in a girl with myelodysplasia. Postoperatively, she remains totally continent on intermittent catheterization.

Child↗
PubMed1982

Detrusor hypertonicity as a late complication of a Wertheim hysterectomy.

An extended radical Wertheim hysterectomy is commonly used in the primary treatment of carcinoma of the cervix. Postoperative voiding dysfunction, characterized by a hypotonic or atonic detrusor, commonly occurs. It is not generally appreciated that hypertonic bladder dysfunction can also occur as a late postoperative complication. We describe 3 patients with postoperative detrusor hypertonia resulting in radiographic changes of the upper urinary tract. The etiology, diagnosis and management of detrusor hypertonia following a Wertheim hysterectomy are discussed.

Aged↗
PubMed1982

Determination of true intravesical filling pressure in patients with vesicoureteral reflux by Fogarty catheter occlusion of ureters.

Ureteroneocystostomy is a highly successful procedure for the correction of vesicoureteral reflux. However, postoperative vesicoureteral reflux or ureterovesical junction obstruction will develop in some patients and elevated intravesical filling pressure might be a significant factor. Reflux, itself, might act as a safety release valve and mask vesical hypertonia. We herein describe a technique to determine the true intravesical filling pressure in the presence of vesicoureteral reflex by occlusion of the ureters with reflux using Fogarty catheters. Our preliminary experience suggests that it is an easily performed and clinically useful test to identify patients with vesical hypertonia who should be treated postoperatively with anticholinergic medication.

Adolescent↗
PubMed1982

The effect of acute phencyclidine administration on cyclopropane requirement (MAC) in rats.

The effect of acute administration of phencyclidine (PCP) on the anesthetic requirement (MAC) was studied in rats. Rats were anesthetized with cyclopropane and MAC determinations were made by the tail-clamp technique. PCP, 2 or 4 mg/kg, subcutaneously, produced a 32 and 42 per cent decrease, respectively, in cyclopropane MAC. The PCP-induced decrease in MAC was not altered by naloxone treatment indicating that an interaction of PCP with opiate mechanisms is unlikely. Central monoamine depletion with reserpine decreased cyclopropane MAC by 20 per cent. In these monoamine-depleted rats, 4 mg/kg PCP produced a further reduction in MAC of 22 per cent. In rats almost totally depleted of catecholamines by pretreatment with reserpine and alpha-methyl-p-tyrosine, a marked (43 per cent) decrease in MAC was observed. The administration of 2 mg/kg PCP, in these catecholamine-depleted rats produced an additional 10 per cent decrease in MAC for a total reduction in MAC of 53 per cent. The effect of PCP in the monoamine- and catecholamine-depleted rats indicates that while an effect on central monoamines may play a part in the mechanism of action of PCP, it is not the sole mode of action of the drug. In patients intoxicated with PCP there is a significant potential for anesthetic overdose as their anesthetic requirement may be much less than would be expected in the nonintoxicated state.

Anesthesia↗
PubMed1981

Urinary undiversion in patients with myelodysplasia and neurogenic bladder dysfunction. Report of a workshop.

This workshop was conducted in an attempt to analyze critically the role of reconstruction of the myelodysplastic patient who had undergone urinary diversion and to develop guidelines for selecting those patients in whom urinary undiversion might be undertaken safely. The collective experience initially seems to be acceptable; however, the authors emphasize the gravity of the decision and the complexity of the evaluation which must be undertaken prior to embarking on such reconstructive surgery. Contrary to some reports, we believe that the defunctionalized bladder frequently can be evaluated. Further, many of the contraindications to urinary undiversion have been identified and several of the hazards involved therein can be avoided. We believe that the neurogenic bladder is no longer an absolute contraindication to undiversion. Our experience suggests that undiversion is a reasonable surgical treatment in select patient with neurogenic bladder dysfunction. But, the decision to remove a satisfactorily functioning conduit must not be undertaken lightly. Patients should be selected only after a thorough, detailed, and properly conducted evaluation. A protocol has been developed which will hopefully assist in this evaluation. Perhaps additional shared experience will further refine and delineate the circumstances appropriate for reconstruction of these patients.

Adolescent↗
PubMed1981

Cellulitis and necrotizing fasciitis of the abdominal wall in pediatric patients.

Soft tissue infections of the abdominal wall in 14 children were classified as cellulitis (8), necrotizing fasciitis (5), or myositis/myonecrosis (1). These 3 categories were characterized by increasing anatomic depth of infection, clinical severity, and need for more radical surgical treatment. Ten of the 14 children were neonates. The most frequent associations were omphalitis (5), necrotizing enterocolitis (4), and urachal anomalies (3). The severest infections were usually polymicrobial and contained both aerobic and anaerobic bacteria. Important clinical findings in children with necrotizing fasciitis and myositis/myonecrosis were tachycardia, systemic toxicity, severe edema, and, in older children, pain out of proportion to the apparent degree of infection. None of the children had fever or crepitation of the wound. An ominous sign, indicative of the need for immediate, radical debridement was the appearance of a patch of dusky or gangrenous skin. There were two deaths associated with delayed diagnosis of necrotizing fasciitis. One child did not receive radical debridement, and the other received it too late to be of benefit. Although these infections are rare in children, their lethal potential and early diagnostic signs must be recognized.

Abdominal Muscles↗
PubMed1981

Prognostic value of urodynamic testing in myelodysplastic patients.

We herein describe the clinical progress of 42 myelodysplastic patients studied urodynamically and followed for a mean of 7.1 years. Urodynamic evaluation included urethral pressure profilometry, simultaneous determination of urethral pressure, intravesical pressure and external anal or external urethral sphincter electromyography with fluoroscopic voiding cystourethrography. Assessment of urethral function showed 36 patients (86 per cent) with an open vesical outlet and nonfunctional proximal urethral. Cystometrography revealed that 7 of 42 patients (17 per cent) had reflex detrusor activity: 4 with coordinated micturition and 3 with detrusor-sphincter dyssynergia. Thirty-five patients (83 per cent) had areflexic detrusor dysfunction: 5 with atomic detrusor response and 30 with a progressive increase in pressure with increasing volume. The intravesical pressure at the time of urethral leakage was 40 cm. water or less in 20 patients and at pressures greater than this value in 22 patients. No patient in the low pressure group had vesicoureteral reflux and only 2 showed ureteral dilatation on excretory urography. In contrast, of the patients in the higher pressure group 15 (68 per cent) showed vesicoureteral reflux and 18 (81 per cent) showed ureteral dilatation on excretory urography. Thus, a striking relationship between the urethral closure pressure and intravesical pressure at the time of urethral leakage and the clinical course in this group of myelodysplastic patients is demonstrated. Every patient with a normally closed vesical outlet was continent on intermittent catheterization and an anticholinergic agent, while only 60 per cent of patients with open bladder outlets similarly treated achieved good urinary control and none was dry. An artificial sphincter device would seem to be a reasonable method to achieve urinary control in the latter patients but the detrusor response to filling also must be considered. Detrusor hypertonia should be controlled or controllable before a sphincter augmenting device can be used safely. Treatment options for patients with high urethral closure pressures include intermittent catheterization and anticholinergic medications or a sphincter ablative procedure to decrease the outlet resistance combined with anticholinergic therapy and implantation of an artificial sphincter. However, only longer followup will determine if these therapeutic regimens will prevent upper urinary tract deterioration.

Electromyography↗
PubMed1981

Diagnostic advantages of fluoroscopic monitoring during urodynamic evaluation.

Clinical abnormalities of micturition exist in which measurements of urethral, bladder and rectal pressures, and electromyography determination do not allow a precise diagnosis. The diagnostic accuracy of urodynamic evaluation can be improved by the addition of fluoroscopic monitoring. It allows the detection of even small amounts of urinary leakage, the recognition of disassociation of electromyography activity of the pelvic floor musculature, the diagnosis of dysfunction of the smooth muscular urethral sphincter and the accurate localization of urethral obstruction. In our experience fluoroscopy is essential to accurate interpretation of urodynamic results.

Adolescent↗
PubMed1980

Necrotizing fasciitis after neonatal circumcision.

A 6-day-old infant had extensive necrotizing fasciitis involving most of the abdominal wall develop after circumcision with a Plastibell device (Hollister, Inc). He survived this life-threatening infection after vigorous cardiovascular support, antibiotic therapy, and aggressive surgical debridement. The diagnosis, bacteriology, and management of necrotizing fasciitis are briefly discussed. The technical aspects and complications of Gomco (Gomco Surgical Manufacturing Corp) and Plastibell circumcision are compared. Strangulation and devitalization of the prepuce is invariably associated with Plastibell circumcision, and it may render neonates circumcised by this technique more susceptible to serious wound infection.

Abdominal Muscles↗
PubMed1980

Suprapubic suspension of Kaufman urinary incontinence prosthesis: new technique.

Many operative procedures have been devised to treat postprostatectomy urinary incontinence. The most widely employed technique today is implantation of the Kaufman urinary incontinence prosthesis. This device maintains continence by passive compression of the bulbous urethra. Unfortunately, it is associated with a 39-per cent failure rate. We have modified Kaufman's operative technique by suspending the posterior straps of the device to the anterior rectus fascia. Passive urethral compression is thus augmented by partial transmission of increases in intra-abdominal pressure. This article describes the details of the surgical procedure and the results in 3 cases.

Aged↗
PubMed1980

Periappendicitis presenting as left renal colic.

Periappendicitis, a variant of appendicitis, is histologically diagnosed in only about 5% of appendices removed for presumptive acute appendicitis. We herein describe a boy with periappendicitis whose clinical presentation was that of left renal colic and partial left midureteral obstruction. Appendicitis not infrequently simulates right ureteral colic. However, to our knowledge appendiceal inflammation never has been reported to stimulate left ureteral colic. Also, complications of appendicitis are known to cause right ureteral obstruction (rarely bilateral) but have not been reported to cause solitary left ureteral obstruction. We found no previously reported case of solitary left ureteral obstruction from appendiceal inflammation or of periappendicitis causing a serious urologic complication.

Adolescent↗
PubMed1980

Urodynamic features of pelvic plexus injury.

Benign and malignant neoplasms arising in and around the pelvic structures may cause urinary obstruction by mechanical compression of the bladder or proximal urethra. These neoplasms less commonly cause neurogenic voiding dysfunction. Herein we describe the urodynamic abnormalities in a young man with massive involvement of the true pelvis with choriocarcinoma. Destruction of the pelvic plexus produced deficits of parasympathetic, sympathetic and somatic innervation of the bladder and urethra. The value of urodynamic evaluation as a neurologic test of thoracolumbar and sacral cord function is demonstrated.

Adolescent↗