Biomedical subjects
Publications and source records attributed to J T Andersen.
A case of a huge right-sided ovarian cyst associated with torsion of the whole internal female genital apparatus around the uterine collum, herniation of the transverse colon into the thoracic cavity and mechanical obstruction of the ileum is described. The symptomatology, pathogenesis and treatment of the condition is discussed.
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The effect of endoscopic bladder neck incision for functional bladder neck obstruction was assessed in 28 consecutive patients with a follow-up period of up to 50 months. The operation had excellent effect on the patients' symptoms consisting mainly of weak stream and/or recurrent urinary infections. Uroflowmetry at the postoperative follow-up study showed a statistically significant increase in as well maximum flow rate as mean flow rate. The bladder neck incision carried very few complications, and the average postoperative stay in hospital was 2.8 days. It is important to be aware of the condition functional bladder neck obstruction, and the diagnosis should be based upon uroflowmetry and voiding cystourethrography. In borderline cases with only slightly reduced urinary flow rate, additional pressure-flow studies should be applied to demonstrate infravesical obstruction.
The cysto-urethroscopic findings in 93 out of 107 consecutive patients referred for symptoms of bladder outlet obstruction were assessed and graded with special reference to bladder wall trabeculation, patency of the bladder neck, prostatic occlusion of the urethra, the estimated prostatic weight and the bladder neck-verumontanum distance. The cysto-urethroscopic findings of trabeculation and prostatic enlargement were not statistically significantly correlated to the cystometric demonstration of detrusor hyperreflexia. However, urodynamic parameters of infravesical obstruction judged by the opening pressure, maximum flow rate and the calculated urethral resistance were statistically significantly correlated to the cysto-urethroscopic findings of prostatic occlusion of the urethra, increased bladder neck-verumontanum distance and an increased prostatic weight estimated at cystoscopy. It is concluded that cysto-urethroscopy gives good information of as well the site as the hydrodynamic severity of organic infravesical obstruction.
1 An in vitro investigation showed that pivampicillin tablets disintegrated more rapidly than pivampicillin capsules. This result was demonstrated and confirmed by gastroscopy in a cross-over study in healthy volunteers. 2 There were no differences in serum levels of ampicillin obtained with the two preparations, but compared with non-gastroscoped volunteers, there was delay of 0.5--1.5 h in the appearance of peak serum ampicillin concentrations after gastroscopy. 3 Half of the volunteers receiving pivampicillin capsules developed hyperaemia, interstitial bleeding or erosions of the gastric mucous membrane. No such reactions were seen after pivampicillin tablets. 4 In one volunteer, a pivampicillin capsule was trapped in a not previously noticed hiatus hernia and local changes and pain occurred.
One hundred consecutive female patients with urinary incontinence were investigated with CO2 cystometry including detrusor reflex activation procedures such as postural change and ability to suppress self-induced detrusor contractions. Detrusor hyperreflexia was seen in 20 patients during bladder filling in the supine position, and in an additional 35 patients after detrusor reflex activation procedures. Four different types of detrusor hyperreflexia are described based on the cystometric findings. In 38 patients treated with parasympatholytics, 66% showed a good result independent of the type of detrusor hyperreflexia.
The bulbocavernosus reflex can be elicited either by penile or urethral stimulation. The mean signal transit time after electrostimulation of the dorsal penile nerve to evoked response in the anal sphincter (35 msec) was only half the signal transit time after stimulation in the posterior urethra (60 msec). Thus, the modified bulbocavernosus reflex elicited either by squeezing the glans penis or by pulling a urethral balloon catheter represents two different reflexes with differenct afferent and probably different intraspinal pathways. In the clinic it is therefore important, when testing the bulbocavernosus reflex, to report how it is elicited.
One hundred and seven consecutive patients referred with symptoms of bladder outlet obstruction were studied using cystometry and combined pressure-flow-electromyographic investigation. The symptoms of infravesical obstruction were not statistically significantly correlated to the hydrodynamic documentation of increased bladder outlet resistance as judged by maximum flow rate and the calculated urethral resistance. Irritative symptoms such as frequency, nocturia, urgency and urgeincontinence were statistically significantly correlated to the presence of detrusor hyperreflexia. The functional disorder bladder neck dyssynergia was encounterd in 5% of the patients (95% confidence limits 1-10%). This diagnosis cannot be made by conventional urological investigations. It is concluded that objective demonstration of infravesical obstruction is mandatory in the selection of patients with symptoms of lower urinary tract dysfunction for surgery on the prostate or the bladder neck.
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Bladder function was studied in 20 healthy elderly male volunteers using cystometry, uroflowmetry and voiding cystourethrography. Two persons were excluded from the study as neurological examination had shown evidence of organic neurological disease, and one person did not complete the study. 53% of the remaining 17 persons had detrusor hyperreflexia. Urinary flow rates were reduced and maximal intravesical pressures elevated in the persons studied, although they claimed to have a normal voiding pattern. No correlation was found between the reduction of urinary flow rate respectively increase in maximal intravesical pressure and the presence of detrusor hyperreflexia. The high incidence of detrusor reflex disturbances thus suggests that incipient infravesical obstruction in old age and possible subclinical impairment of the central nervous control of the micturition reflex are major etiological factors in detrusor hyperreflexia.
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The technique of combined electromyographic and carbon dioxide urethral pressure profilometry is described and analyzed. The low viscous drag of carbon dioxide permits the use of catheter infusion rates above the critical threshold, where the compressibility of the gas does not influence the accuracy of the pressure recording. Clinical urethral function studies with this technique in benign prostatic hypertrophy, stress incontinence and traumatic spinal cord injury have documented the diagnostic value of the test. Furthermore, the impact of surgical or pharmacological treatment upon urethral function has been delineated.
Changes in the concept of neural organization for micturition and the use of high flow gas cystometers have altered the performance of clinical cystometry and test interpretation. Detrusor reflex activation procedures in carbon dioxide cystometry include rapid bladder distension, change in postural states, use of bethanechol, urethral and anal distension, and sleep. Sleep cystometry requires the use of electroencephalography. These procedures have permitted specific delineation of the syndrome of detrusor reflex instability. Test interpretation is based upon detection of the presence of detrusor reflex instability or end organ denervation.
Seven spinal cord injury patients were studied before and after transurethral external sphincterotomy with combined electromyographic and gas urethral pressure profilometry. The technique was simple, rapid, accurate and reproducible in evaluating the completeness of external sphicterotomy. A significant reduction in maximum urethral closure pressure, as well as in the residual urine volume, was a consistent after spincterotomy. The electromyographic profile showed evidence of periurethral striated muscle activity preoperatively in 2 patients with lower motor neuron lesions in whom the bulbocavernosus reflex could not be elicited. Thus, absence of the bulbocavernosus reflex did not eliminate sphincter reflex activity.
In a retrospective study of 579 patients with cystometrically proven detrusor hyperreflexia bacteriuria was correlated to the commonly accepted etiologies, and to the duration and amplitude of the uninhibited bladder contractions. Blood flow in the bladder wall may be reduced by increased intravesical pressure due to detrusor hyperreflexia, and it has been suggested that a resulting weakening of antibacterial defense mechanisms is responsible for the majority of urinary tract infections in these patients. We have not been able to confirm this hypothesis. We found no statistically significant difference between the incidence of bacteriuria in patients with low amplitude and short duration of the bladder contractions and in patients with high amplitude and long duration of the uninhibited bladder contractions.
Intravenous pyelographies from 104 consecutive patients admitted for infravesical obstruction were studied with special reference to pathology of the upper urinary tract and the bladder, the size of the prostate and the bladder emptying. The incidental findings in the upper urinary tract did not influence the treatment of the infravesical obstruction. Furthermore the radiographic assessment of prostatic size, bladder trabeculation, bladder emptying, bladder stones and prostatic cancer was very uncertain. Thus intravenous pyelography in our opinion should not be performed as a routine procedure in patients with benign prostatic hypertrophy, but only on clinical suspicion of upper urinary tract pathology.
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