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Biomedical subjects

R Voigt

Publications and source records attributed to R Voigt.

At least 37 records · Page 2Linked to original sources
PubMed2000

Responses of anterior lateral line afferent neurones to water flow.

The mechanoreceptive lateral line system detects hydrodynamic stimuli and plays an important role in a number of types of fish behaviour, including orientation to water currents. The lateral line is composed of hair cell receptor organs called neuromasts that occur as superficial neuromasts on the surface of the skin or canal neuromasts located in subepidermal canals. Both are innervated by primary afferents of the lateral line nerves. Although there have been extensive studies of the response properties of lateral line afferents to vibrating sources, their response to water flow has not been reported. In this study, we recorded extracellularly from anterior lateral line afferents in the New Zealand long-fin eel Anguilla dieffenbachii while stimulating the eel with unidirectional water flows at 0.5-4 cm s(-)(1). Of the afferents, 80 % were flow-sensitive to varying degrees, the response magnitude increasing with flow rate. Flow-sensitive fibres gave non-adapting tonic responses, indicating that these fibres detect absolute flow velocity. Further studies are needed to confirm whether flow-sensitive and flow-insensitive fibres correlate with superficial and canal neuromasts, respectively.

Anguilla↗
PubMed2000

Differentiated therapy with prostaglandin E1 (alprostadil) after orthotopic liver transplantation: the usefulness of procalcitonin (PCT) and hepatic artery resistive index (RI) for the evaluation of early graft function and clinical course.

Increasing demand for donor organs has led to new pharmacological concepts for reducing ischemia-reperfusion injury (I/R) of the graft after liver transplantation to prevent primary non-functioning of the organ. Prostaglandins have proved to be cytoprotective in several experimental models of ischemia and transplantation. The prophylactic administration after orthotopic liver transplantation is still a subject of controversial discussion. The aim of our study was the evaluation of the post-transplant hepatic artery resistive index (RI) measured by color Doppler imaging, in combination with postoperative elevation of transaminases, as parameters indicating the need for a differentiated systemic therapy with prostaglandin E1 (PGE1) (alprostadil). In addition, the value of serum procalcitonin (PCT) as a postoperative parameter for the extent of I/R is investigated. In the case of post-transplant elevated hepatic artery RI (RI > 0.75), the administration of PGE1 led to a significant reduction of transaminases (p < 0.05) and a decline of the RI. In addition, postoperative PCT levels could be reduced significantly by PGE1 application. These results suggest that determination of RI is feasible for indicating a need for therapy with PGE1. Its targeted application reduces hepatocellular damage due to I/R after liver transplantation.

Alprostadil↗
PubMed2000

[Suspension of the lower third of the urethra in ambulatory practice--minimally invasive treatment of urinary stress incontinence--technique and initial experience].

OBJECTIVE: The aim of the article is the presentation of a new, mini-invasive method for the treatment of urethral incompetence in women--TVT (tension-free vaginal tape). DESIGN AND SETTING: The design was a prospective comparison of the first 10 patients at the Department of Obstetrics and Gynaecology of the 1st Medical Faculty and General Faculty Hospital in Prague where urethral incompetence = genuine stress incontinence regardless of their history was diagnosed consecutively. METHODS: We present the technique of the operation, examination procedure including the application of dynamic magnetic resonance before and after operation at rest and under Valsalva, the subjective and objective outcome in the analyzed group. We compare also the parameters of urethrovesical junction mobility in the MR image and discuss their importance for the new continence mechanism in the TVT method. RESULTS: All patients are 10-18 months after the operation continent. The functional morphology of the lower urinary tract and of the pelvic floor on the MR image after TVT did not reveal any relevant changes in bladder neck dynamic mobility. CONCLUSION: The experience of other authors concerning possible complications, postoperative care and results are evaluated; they are without exception positive.

Ambulatory Surgical Procedures↗
PubMed1999

A placebo-controlled, multicentre study comparing the tolerability and efficacy of propiverine and oxybutynin in patients with urgency and urge incontinence.

OBJECTIVE: To assess the tolerability and efficacy of propiverine and oxybutynin in patients with urgency and urge incontinence in a randomized, double-blind placebo-controlled clinical trial. PATIENTS AND METHODS: In all, 366 patients (149 on propiverine, 145 oxybutynin and 72 placebo, ratio 2:2:1) with urgency and urge incontinence were recruited in 32 study centres. Propiverine (group 1, 15 mg three times daily), oxybutynin (group 2, 5 mg twice daily) or placebo (group 3) were administered for 4 weeks, using the double-dummy technique. The dosages were selected specifically to compare the tolerability profile of propiverine with the commonly used therapeutic dosage of oxybutynin. Tolerability was assessed by directly questioning the patients about adverse events at four visits (V-1 before and V0 after a 1-week 'washout' period, V1 after 1 week and V4 after 4 weeks of treatment) during a 5-week surveillance period, and by tolerability ratings of the physicians. Efficacy was assessed using urodynamics at V0 and V4, evaluating the cystometric bladder capacity at maximal and first desire to void, and postvoid residual urine, according to the criteria of the International Continence Society. Additionally, a voiding protocol, overall assessment of clinical symptomatology and efficacy ratings by the physicians were documented. RESULTS: A remarkably high percentage of adverse events was reported in the washout period (VO: 13%, 16% and 18% in groups 1-3, respectively). At V4, the clinically most relevant symptom (dry mouth) occurred in 53% of patients in group 1, in 67% of group 2 and in 28% of group 3. Furthermore, dry mouth was less severe in group 1 than group 2. In contrast to groups 2 and 3, only patients in group 1 showed increasing tolerability during the treatment (from V1 to V4). These tolerability results were further supported by the overall tolerability assessment ('very good' or 'good' tolerability in 67% of group 1, in 59% of group 2 and in 83% of group 3). The urodynamic assessment of efficacy (comparing V0 and V4) showed a statistically significant increase in the mean (sd) maximal cystometric bladder capacity in group 1, being 222 (77) mL at V0 and 311 (125) mL at V4, an increase of 89 (108) mL, and in group 2, at 226 (75) mL and 322 (123) mL, an increase of 96 (106) mL, compared with group 3, at 211 (77) mL and 263 (93) mL, an increase of only 52 (92) mL. The cystometric bladder capacity at first desire to void also increased in group 1 (93 to 160 mL) and group 2 (89 to 160 mL), whereas in group 3 there were only minor changes (93 to 120 mL). Changes in the residual urine volume within and between the treatment groups were minimal and clinically irrelevant. The overall assessment of efficacy showed significant differences between the drugs when compared with placebo. CONCLUSION: Propiverine is a safe and effective drug in the treatment of urgency and urge incontinence; it is as effective as oxybutynin, but the incidence of dry mouth and its severity is less with propiverine than with oxybutynin. The availability of alternative pharmacotherapeutics such as propiverine should reduce the therapeutic failure rate and improves the success rate in the treatment of patients suffering from urgency and urge incontinence.

Benzilates↗
PubMed1999

[Ultrasound imaging of the lower urinary tract in post-menopausal women with urinary stress or combined type of incontinence before and after intravaginal administration of estriol].

The finding that climacteric symptoms are caused mainly by a decline of the oestrogen level and that their development can practically always be prevented by long-term local or general oestrogen treatment was a great asset to the treatment of this problem. Oestriol, a less effective natural oestrogen, has a favourable effect on urogenital tissues without stimulating the endometrium [2]. The objective of the present investigation was to analyze ultrasonographic parameters of the lower urinary tract in women after the menopause with the stress or mixed type of urinary incontinence before and after two-month local oestriol treatment (Ovestin). The trial comprised 40 women with confirmed stress (GSI) or the mixed type of urinary incontinence. The group with GSI comprised 124 patients and the group suffering from the mixed type of incontinence comprised 26 women. The type of incontinence was assessed by urogynaecological examination. This was followed by transperineal and introital ultrasound examination of patients in a supine position by means of an Acuson 128 XP10 apparatus using a convex probe with a frequency of 5 MHz and a vaginal probe with a frequency of 7.0 MHz. Assessment of the position and mobility of the urethrovesical junction was implemented by the transperineal route using a convex probe and filling the bladder with 300 ml. After urination followed assessment of the urethral sphincter by the introital route in a vertical plane whereby the authors followed the anterior and posterior surface of the rhabdosphincter, and in a horizontal plane its left and right surface (10). The authors assessed also in both planes the maximal thickness of the sphincter. In the vertical plane and in a proximal position in relation to the urethra they evaluated the vascular supply qunatitatively (minimal-1 to very abundant-4) and also the arterial flow-the pulsatile index PI was investigated as well as the resistance index RI. In the vertical plane 1 cm from the urethrovesical junction the authors assessed the thickness of the urethral mucosa; at the same level they evaluated the thickness of the urinary bladder wall; the anterior wall, the vertex and the area of the trigone. They assessed also the thickness of pelvic floor muscles. The assessments were made before and after two-month intravaginal oestriol administration (Ovestin crm)-two weeks 0.5 mg/day and then 0.5 mg twice a week. After treatment no statistically significant differences in thickness and areas of the urethral sphincter were found nor in the thickness of the pelvic floor muscles before and after oestriol administration. Statistically significant differences were recorded in the mobility of the urethrovesical junction and there was a significant increase in the thickness of the urethral mucosa and a more abundant vascularization was recorded during the quantitative evaluation and evaluation of PI. In women with the mixed type of incontinence after oestrogen treatment a decline in the thickness of the urinary bladder was found. Ultrasound examination of the lower urinary tract before and after oestriol treatment (Ovestin crm) is a useful supplement of common examination methods and it confirms its favourable therapeutic effect when administered by the intravaginal route.

Administration, Intravaginal↗
PubMed1998

[Hormone therapy and urogynecology].

The female genital and urinary systems exists in close anatomical and functional proximity, disorders of one resulting in dysfunction of the other. The investigation and management of lower urinary tract disorders must take this important relationship into consideration, as neither can be viewed in isolation. The value of estrogen replacement therapy as a treatment of urinary incontinence is controversial and until today there is a little substantial evidence to conclude that estrogen therapy alone is of value in the treatment of this symptom. This conflicting evidence concerning the therapeutic benefit of estrogen therapy in stress urinary incontinence seems to be outweighed with other advantages of estrogen replacement therapy. Clear evidence exists to suggest that recurrent urinary tract infections can be prevented or even treated by the use of estrogen therapy. Systemic estrogen replacement appears to relieve the symptoms of urgency, urge incontinence, frequency, nycturia and dysuria, and low-dose topical estrogen is effective in the management of atrophic vaginitis. Even with postulating the HRT to be of enormous therapeutic value to postmenopausal women in urogynecology it may stay only a mean of support of other causal methods of treatment of dysfunction of lower urinary tract.

Estrogen Replacement Therapy↗
PubMed1998

[Changes in the position of the ureterovesical junction during maximal voluntary contractions and during maximal vaginal electric stimulation of the pelvic floor muscles].

The objective of the study was to evaluate and compare the effect of the maximal voluntary muscle contraction of the pelvic floor (PFM) and contractions of the PFM evoked by maximal electric stimulation using an electrostimulation apparatus Conmax by monitoring the position of the urethrovesical junction by ultrasound. The trial comprised 20 women with confirmed stress incontinence of urine. With the patients in a supine position with abducted lower extremities an electrostimulation probe was inserted into the vagina. This was followed by perineal ultrasound (US) examination using an ACUSON 128 XP-10 apparatus and a convex tube 5 MHz. The ultrasound examination was made using the electrostimulation probe--at rest and during maximal voluntary contraction of the PFM. This was followed by maximal electric stimulation and after five minutes during stimulation the US examination was repeated. It was performed also during maximal electric stimulation (MES) concurrently with maximal voluntary contraction of the PFM. For electrostimulation a Conmax appartus was used. The applied frequency was 50 Hz, amplitude from 0 to 90 mA (grade 0-6), duration of pulse 0.75 ms. The maximum intensity of stimulation was determined by the patient, i.e. when stimulation was not yet painful. During US the authors investigated the gamma angle, i.e. the angle between the axis of the symphysis and the connecting line between the UV junction and the lower borderline of the symphysis. The mean difference of the gamma angle during voluntary contraction of the PFM and at rest was 13.6. During contraction caused by maximal electric stimulation of the PFM and at rest this difference was 21.3. The difference did not differ significantly during maximal electric stimulation of the PFM and during maximal electric stimulation and voluntary contraction of the PFM. From the trial ensues that contraction of the pelvic floor muscles during maximal electric stimulation is stronger as compared with the intensity of contraction caused by maximal voluntary contraction. The results confirm the favourable therapeutic effect of MES muscles of the pelvic floor in the treatment of urinary incontinence in women. These changes help to increase the muscular tonus and contractibility of pelvic floor muscles and thus promote also elevation of the neck of the urinary bladder. Elevation of the neck of the urinary bladder promotes normalization of intraabdominal transfer of pressure to the proximal urethra.

Electric Stimulation Therapy↗
PubMed1998

[Ultrasonography of pelvic floor muscles in women with urinary stress incontinence].

Ultrasound examinations have become since beginning of the eighties one of the auxiliary examination methods in urogynaecology. Evaluation of the position and mobility of the neck of the urinary bladder practically replaced lateral chain urethrocystography. With the improving differentiating capacity of ultrasound equipment it is possible to visualize some periurethral and paravaginal structures which participate in the support of the urethra and urethrovesical junction by paravaginal and periurethral structures in women (fig. 1). In recent years many papers were published where for visualization nuclear magnetic resonance (NMR) is used [1, 12, 19]. The functional and physiological condition of these tissues is assessed by physical, urodynamic and ultrasonographic examinations and also by cystourethroscopy and manometry [7, 11, 10, 13, 14, 15, 16]. Despite this the greater part of anatomical knowledge of the supporting apparatus is derived from pathological studies and peroperative observations.

Female↗
PubMed1998

[Ultrasonic imaging of the lower urinary tract in women with urinary stress incontinence and in women after the Burch colpopexy].

The prevalence of urinary incontinence varies from 5% in young to 50% in elderly women. The weak anatomical support of the urethrovesical junction, base of the urinary bladder and proximal urethra lead to its prolapse and hypermobility which is considered the main anatomical basis of stress incontinence. The majority of surgical procedures which resolve this problem describes elevation of the cervix of the urinary bladder. The final step of these operations, i.e. how much the urethrovesical junction should be pulled up, is described only rarely and superficially. The clinical consequence which may develop are complications associated with hypercorrection of the posterior urethrovesicular angle, i.e. problems with micturition-difficult micturition, or stage-wise micturition and symptoms of detrusor instability. The objective of the present investigation was: to analyze ultrasonic parameters of the lower urinary tract in women with stress incontinence (GSU), furthermore in women after colpopexy by Burch's method, and with regard to these results, possibly modify the surgical procedure. In the investigation in the first group 30 women were enlisted with confirmed stress incontinence. The second group was formed by 30 women three to nine months after colpopexy. The ultrasound examination was made by the perineal and introital route with the patient in a supine position, using a Acuson 128 XP 10 apparatus with a convex probe with a frequency of 5 MHz and by means of as vaginal probe with a frequency of 7.0 MHz. Assessment of the site and mobility of the urethrovesical junction was made by the transperineal route by means of a convex probe with a 300 ml filling of the urinary bladder; after micturition assessment of the areas of the urethral sphincter in a vertical and horizontal plane followed. In the vertical plane and anterior surface of the sphincter also the blood flow was measured and the pulsatile index (PI) and resistance index (RI) were assessed. The authors investigated also the thickness of the pelvic floor muscles and in the vertical plane the thickness of the urinary bladder wall on the anterior wall, in the vertex and in the area of the trigon. The authors found significant differences in ultrasound parameters in groups of women with GSI and women after colpopexy as regards the site and mobility of the urethrovesical junction and thickness of the urinary bladder wall (p < 0.01). In women with symptoms of urgency after colpopexy the authors found a mean thickness of the urinary bladder wall of more than 5 mm and mean values of the gamma angle smaller than 40 degrees and they recorded also a reduced mobility of the urethrovesical junction. These findings confirmed their expectations that in women with persisting symptoms of urgency frequently slight hypercorrection of the position of the urethrovesical junction is involved. These findings are important for the correction of the surgical approach and the evaluation of the above mentioned parameters is helpful in the diagnosis of urgency.

Female↗
PubMed1997

Sex, drugs and HIV counseling and testing: a prospective study of behavior-change among methadone-maintenance clients in New England.

OBJECTIVES: To determine whether changes in injecting drug use and sexual behavior over a 12-month follow-up are associated with HIV counseling and testing (C and T) of injecting drug users in methadone maintenance treatment programs (MMTP) in Massachusetts and Connecticut. METHODS: Clients were invited to participate in a longitudinal study involving five interviews. Data were also obtained by ethnographers and from clinical records. Behavioral outcomes of interest were number of drug injections, sharing of unclean 'works' (injecting equipment), number of unprotected sex partners, and number of unprotected sexual episodes. Data analyses included multiple regression, odds ratios, and quantitative analysis of text-based data. RESULTS: Subjects reported reductions in both injecting drug use and sexual behavior Primary associations with reduced injecting drug use were remaining in the MMTP and attending HIV-positive support groups. A reduction in high-risk sexual behavior was associated with an HIV-positive test result and duration of HIV counseling in the MMTP. Increase in drug injecting use was associated with an HIV-positive test result. Inconsistent condom use was associated with enrollment in the MMTP where condoms were available only upon request and abstinence and monogamy between uninfected partners were promoted. CONCLUSIONS: Injecting drug users who self-select to participate in MMTP and HIV C and T, two public health HIV-prevention interventions, reduce their HIV-risk behaviors. Clients should be encouraged to remain in MMTP and HIV-infected clients should attend support groups for HIV-positive persons. MMTP staff should promote a variety of safer sex behaviors and provide condoms without request.

Adult↗
PubMed1997

[Does maximum short-term electric stimulation cause contraction of the pelvic floor muscles?].

Electric stimulation is successfully used in the treatment of the stress and urgent type of incontinence. Electric stimulation of the muscles of the pelvic floor causes reflex contraction of the striated peri- and paraurethral muscles and is associated with concurrent reflex inhibition of the detrusor muscle. The therapeutic results depends greatly on the total or at least partially preserved innervation of the muscles of the pelvic floor by the pudendal nerve. One of the possible stimuli of the pelvic floor muscles is maximal electric stimulation (MES) and the objective of our study was to evaluate the effect of MES on the muscles of the pelvic floor or to detect possible changes by US and urodynamic examination. The study comprised women with the stress type of incontinence (GSI). The group was formed by 40 women with GSI, 20 were subjected to US examination and urodynamic examination (n = 20). The group of subjects subjected to urodynamic examination was extended to 40 (n = 40). For electrostimulation a Conmax apparatus was used. The applied frequency was 20 Hz, the amplitude from 0 to 90 mA (grades 0.6), pulse duration 0.75 ms. During the cystometric examination the authors recorded a significant increase of the maximal urethral closure pressure (MUCP), prolongation of the functional (FUL) and anatomical length (AUL) of the urethra during MES. During US examination the authors recorded a significant diminution of the gamma angle, a reduction of the mobility of the UV junction and prolongation of the anatomical length of the urethra during MES. From the investigation ensues that the pelvic floor muscles are contracted during MES and those changes contribute to an increase of the muscular tonus and contracting capacity of the muscles of the pelvic floor and thus cause among other things elevation of the neck of the urinary bladder. The elevation contributes to the normalization of the intraabdominal transmission of pressure to the proximal urethra and thus to treatment of the stress type of urinary incontinence.

Electric Stimulation Therapy↗
PubMed1997

[Tolerance and effectiveness of propiverine hydrochloride in 752 patients with symptoms of detrusor hyperactivity and increased sensitivity and irritability of the urinary bladder: results of a study monitoring drug utilization].

In a post-marketing surveillance study of 752 patients suffering from urgent incontinence, mixed urgent-stress incontinence, reflex incontinence, urgency and enuresis were treated with propiverine hydrochloride. Clinical efficacy of propiverine hydrochloride was verified by the improvement of symptoms related to detrusor hyperactivity, hypersensitivity and hyperreflexia during a 12-week surveillance period: daytime and overnight urinary incontinence, as well as the frequency, nocturia, urgency in day time and at night decreased. These results are well demonstrated by decreased pad use and statistically significant decrease of Gaudenz urgency score during treatment, confirming the efficacy of propiverine hydrochloride already proved in clinical trials. The safety profile of propiverine hydrochloride displayed characteristic anticholinergic symptoms (dry mouth, accommodation disorders, constipation, tiredness, dizziness) with decreasing incidence during the 12-week treatment period. The residual urine volume decreased also. Serious adverse events were observed rarely and could be explained by the lack of consideration of contraindications, warnings and interactions with other drugs. The positive risk-benefit relationship of propiverine hydrochloride in the treatment of detrusor hyperactivity, hypersensitivity and hyperreflexia was reconfirmed in this post-marketing drug surveillance study.

Adolescent↗
PubMed1997

[Ultrasound imaging of the urethral sphincter].

The integrity and functional capacity of the urethral sphincter is one of the important prerequisites of urinary incontinence in women. Urodynamic investigations revealed repeatedly that the maximum closure pressure in the median portion of the urethra corresponds to the maximal thickness of the external urethral sphinctor (rhabdosphincter urethrae). This striated muscle is adapted to maintain a relatively steady tonus which assists the closure mechanism of the urethra [4]. In the submitted study the authors focused attention on the ultrasonic visualization of the internal urethral sphincter in order to assess the relationship between the size of this sphincter and the stress type of incontinence (genuine stress incontinence-GSI). The investigation comprised thirty women with confirmed GSI and a control group of thirty asymptomatic volunteers. During perineal ultrasonic examination of women in a supine position by means of an ACUSON 128 XP 10 apparatus using a convex probe with a frequency of 5 MHz the authors recorded statistically significant differences in the areas and maximal thickness of the urethral sphincter in women with stress incontinence and symptom-free women. From the results ensues that the size of this muscle is much smaller in women suffering from GSI.

Adult↗
PubMed1996

[Changes in the position of the urethra and bladder neck during pregnancy and after delivery].

It is estimated that some 30-50% women suffer occasionally from urinary incontinence. At the end of pregnancy these complaints are more marked. In the author's group of 44 women 55% suffered from stress incontinence. The psychosocial impact of impaired function of the lower urinary pathways in women on different spheres of the patient's life is so serious that it calls for a qualified approach of a specialist. The increased mobility of the UV junction in incontinent women has been described by several authors [6, 12, 13]. It was also proved in the author's investigation closely before delivery and 3-5 days after delivery. Six weeks after delivery no differences were found in the mobility of the UV junction in continent and incontinent women. If the difference of the gamma angle (formed by the axis of the symphysis and the connecting line between the UV junction and the lower margin of the symphysis) during contraction of the muscles of the pelvic floor and Valsalva's manoeuvre (intraabdominal pressure raised by 30 cm H2O) is more than 30 degrees during the 40th week of gestation or 3-5 days after delivery (when this mobility is even greater), then the woman is liable to develop the stress type of incontinence and the authors recommend to use Kolpexin after the puerperium for exercise and strengthening of the muscles of the pelvic floor. Changes in the length of line p and angle beta are not statistically significant and cannot assess the disposition for development of urinary incontinence.

Adult↗