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Biomedical subjects

S A Awad

Publications and source records attributed to S A Awad.

At least 55 records · Page 3Linked to original sources
PubMed1978

Alpha-adrenergic agents in urinary disorders of the proximal urethra. Part I. Sphincteric incontinence.

Phenylpropanolamine, an alpha receptor stimulant, was found effective in 11 of 13 female and 6 of 7 male patients with sphincteric incontinence. In all the male patients except 1, the incontinence has followed prostatectomy. Side effects occurred in only 1 patient. As a rule, the benficial response depended on the therapy being continued. The results are consistent with the distribution of alpha receptors and their effect in the proximal urethra.

Adrenergic alpha-Agonists↗
PubMed1978

Alpha-adrenergic agents in urinary disorders of the proximal urethra. Part II. Urethral obstruction due to "sympathetic dyssynergia".

Lower urinary tract obstruction in patients with neurological lesions can be due to "sympathetic dyssynergia". The obstruction can be at the level of the external sphincter. Phentolamine (i.v.) used during the voiding cystourethrogram helps to make the diagnosis. Phenoxybenzamine therapy produced improvement in 10 of 18 patients. As a rule, patients had to continue on the drug to maintain their response.

Adrenergic alpha-Antagonists↗
PubMed1977

Sympathetic dyssynergia in the region of the external sphincter: a possible source of lower urinary tract obstruction.

Voiding cystourethrography demonstrated urethral constriction at the level of the external urinary sphincter in 10 patients with neurological dysfunctions. Ten mg. phentolamine mesylate intravenously alleviated this constriction, permitting better flow and reducing residual urine in 5 patients with a traumatic spinal injury, 2 with transverse myelitis and 1 who had had a cerebrovascular accident. Oral therapy with phenoxybenzamine hydrochloride, used in 7 of the 8 patients, reduced the post-void residual urine and produced improvement in hydronephrosis when present. These observations are consistent with the presence of a significant sympathetic component to obstruction at the region of the external sphincter in certain neurological disorders.

Humans↗
PubMed1977

Urethral pressure profile during the spinal shock stage in man: a preliminary report.

The functional state of the proximal urethra in the spinal shock stage in man is not fully understood. We studied patients with spinal cord injuries during spinal shock and found that the urethral pressure profile had a normal configuration, the peak profile pressure increased with bladder filling and phentolamine (10 mg. intravenously) reduced the peak pressure, with empty and full bladders.

Adult↗
PubMed1977

The treatment of the uninhibited bladder with dicyclomine.

Symptomatic treatment of the uninhibited bladder has presented a challenge because of the lack of an effective, well tolerated smooth muscle relaxant for the bladder that can be used during an extended interval. In a preliminary study oral dicyclomine produced resolution or significant improvement of symptoms in 24 of 27 patients and an increase in bladder capacity by an average of 137 plus or minus 26 ml. (91 plus or minus 22 per cent) after 8 weeks of therapy. Additional controlled trials definitely are warranted.

Administration, Oral↗
PubMed1977

Carcinoma of the prostate: a critical look at staging.

To stage accurately the extent of the disease comprehensive investigations were done on 75 patients with histologically documented carcinoma of the prostate. Estimation of bone marrow acid phosphatase appears to be the most sensitive test to detect blood-borne metastases. Serum acid phosphatase appears to be of little value in the detection of early blood spread and may have a role only in monitoring the effect of treatment on advanced disease. Bone scanning with technetium compounds has the disadvantage of non-specificity but has far greater sensitivity than a skeletal survey. Bone marrow cytology was not rewarding in the detection of early metastatic disease. Pedal lymphangiography is a highly inaccurate method to detect lymphatic spread of carcinoma of the prostate and pelvic lymphadenectomy, when indicated, remains the only truly adequate method to assess lymph node involvement. There was a 37 per cent incidence of metastatic lymph node pathology in 30 patients undergoing this procedure before either radical prostatectomy or deep x-ray therapy. A close correlation was found between stage and grade of disease and incidence of nodal pathology. There was some correlation between degree of nodal involvement and evidence of blood spread as detected by elevated bone marrow acid phosphatase levels. The significance of this finding remains unclear.

Acid Phosphatase↗
PubMed1977

The adrenergic component in the proximal urethra.

Two experimental systems are described in which simultaneous radiological and perfusion pressure monitoring of proximal urethral function can be carried out. In one series of experiments, hypogastric nerve stimulation and noradrenaline administration caused urethral constriction while isoprenaline caused dilatation. Using a model similar to a stress cystogram, hypogastric nerve section resulted in opening of the urethra earlier under the same stress, and wider when a steady flow was established. This effect was greater than the influence of parasympathetic or somatic nerve supplies to the urethra. It was concluded that sympathetically innervated smooth muscle has a significant influence on urinary continence and urethral wall tension.

Adrenergic Fibers↗
PubMed1977

Antimuscarinic and noncompetitive antagonist properties of dicyclomine hydrochloride in isolated human and rabbit bladder muscle.

In isolated strips of bladder neck (prostatic capsule) and detrusor of rabbit and man, dicyclomine had minimal effect on the resting tension. Competitive antimuscarinic activity against carbachol could be demonstrated at doses of dicyclomine less than or equal to 1 X 10(-6) M, whereas at higher doses a noncompetitive action against both carbachol and potassium was observed. The ratio of dissociation constants relating to the noncompetitive and competitive actions, respectively, was about 1200, approximately 100 times higher than that previously reported in ileum. Dicyclomine was only about 1/30 as potent as atropine in competitive antimuscarinic activity. Dicyclomine hydrochloride may be useful in the clinical management of "uninhibited bladder."

Animals↗
PubMed1976

Sympathetic activity in the proximal urethra in patients with urinary obstruction.

The effect of 10 mg. phentolamine intravenously on the urethral pressure profile was studied in male and female patients with lower urinary tract obstruction. A significant decrease of pressure occurred along the whole length of the urethra in both sexes, including the peak pressure zone in the male patient. This zone has been traditionally attributed to the external sphincter. It was concluded that the sympathetically innervated smooth muscle exerts a certain activity along the whole length of the proximal urethra. The phentolamine test may prove to be a useful adjunct to urethral profile studies in patients with lower urinary tract obstruction.

Adult↗
PubMed1976

Relative contributions of smooth and striated muscles to the canine urethral pressure profile.

Canine urethral pressure profiles were analysed using pharmacological and nerve sectioning techniques. The presence of significant sympathetic and somatic neural components was detected and their locations along the proximal urethra were identified. The neural components peaked at different points in the urethra but overlapped. The non-neural component appeared to form an even base along the whole proximal urethra. It was concluded that in the proximal part of the profile the non-neural and the sympathetic components are significant. The sympathetic component becomes larger in the peak pressure zone. More distally and overlapping with the sympathetic component is the contribution of the striated external sphincter.

Animals↗
PubMed1976

The effect of adrenergic drugs and hypogastric nerve stimulation on the canine urethra. A radiologic and urethral pressure study.

A combination of fluoroscopy and measurement of changes in urethral resistance was used to identify the nature and location of the urethral response to adrenergic stimulation. Intraaortic norepinephrine or bilateral hypogastric nerve stimulation produced a constriction of the prostatic urethra in males and of the distal urethra in females. Intraaortic isoproterenol produced a dilation in the same regions. The adrenergically sensitive areas determined in this study appear more discrete than those determined by measurements of urethral pressure profile.

Animals↗
PubMed1976

Role of neurogenic factors in canine urethral wall tension and urinary continence.

A plastic disc, secured submucosally, was inserted in the canine bladder to permit filling of the bladder neck region while bypassing the accommodating ability of the detrusor. The bladder neck region was distended with radiopaque solution and the onset of flow in the urethra and the width of the urethra at steady state flow conditions were monitored by fluoroscopy. Perfusion pressure was also recorded. Bilateral section of the hypogastric nerves produced a substantial reduction in the time to initial flow and an increase in the width of the urethra with a decrease in pressure at steady state flow. Bilateral section of the pelvic nerves or administration of atropine reduced urethral wall tension at steady state flow but did not significantly influence the onset of initial flow. Gallamine treatment had no significant effect either on wall tension or on the onset of initial flow. It was estimated that the sympathetic nervous system contributed about 30 per cent to the urethral wall tension at steady state flow conditions whereas the parasympathetic nervous system contributed about 10 per cent. The remaining 60 per cent was attributed to the elastic properties of the urethra. In the maintenance of urinary continence, the sympathetic nervous system was estimated to contribute almost 60 per cent based on our experimental system. No other neurogenic influence was found to contribute significantly. Elastic and mechanical (anatomic) factors were probably responsible for the remaining 40 per cent. It was concluded that the sympathetic nervous system has a significant role in the maintenance of urinary continence.

Animals↗
PubMed1976

A catheter withdrawing apparatus for clinical urethral pressure profile studies.

An apparatus for withdrawing a urethral catheter at a constant speed is described. The motor and the puller assembly are separate components so that the puller assembly can be autoclaved. By matching pulling speed to recorder chart speed a reproducible representation of urethral length can be obtained without using a displacement transducer. The apparatus has been used clinically for measuring urethral pressure profiles.

Adult↗
PubMed1975

A difference in sensitivity to alpha-adrenergic agonists exhibited by detrusor and bladder neck of rabbit.

In cumulative dose-response studies, strips from bladder neck of rabbit were significantly more sensitive to stimulation with noradrenaline, phenylephrine, and methoxamine than were strips from detrusor. There was no difference between the two regions in sensitivity to isoprenaline or carbachol. From the known characteristics of these agents, it seemed unlikely that metabolic destruction or uptake could account for the different sensitivities seen. Also, neither normetanephrine nor desmethylimipramine could alter significantly the potency of noradrenaline in either area of the bladder. It seems likely that the difference in sensitivity to alpha-adrenoceptor stimulation in the bladder neck and detrusor is due to factors at the receptor level.

Adrenergic alpha-Agonists↗
PubMed1974

The problem of catheter encrustation.

Catheter encrustation was studied in a group of long-stay hospital patients using both latex and silicone catheters. Moisture accounted for 80% by weight of the encrusted material with both catheters. Of the dry weight 90% was composed of protein, calcium, phosphorus, magnesium and uric acid. No relationship was found between the amounts of these substances in the urine and in the encrusted material. High levels of calcium, phosphorus and magnesium were found in the encrusted material from patients infected with Proteus organisms. No direct relationship was found between the duration of catheter drainage and the degree of encrustation, and there was a variation in patient susceptibility to encrustation irrespective of the catheter material. There was significantly less encrustation associated with silicone catheters.

Calcium↗
PubMed1974

Emphysematous pyelonephritis.

A case of emphysematous pyelonephritis with perirenal gas is presented. This patient underwent vigorous medical treatment followed by nephrectomy and survived. This condition has a high mortality and should be distinguished from less severe infections where gas is confined to the collecting system. This case and others previously reported suggest that treatment should initially be medical, followed by early surgical intervention consisting of either drainage or nephrectomy depending upon the degree of renal involvement.

Adult↗