The right colonic segment as reservoir for urine.
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Bacteriuria↗
Biomedical subjects
S Colleen
Publications and source records attributed to S Colleen.
Bacillus Calmette-Guérin treatment of 39 patients with superficial transitional cell carcinoma of the bladder.
The effect of intravesical Pasteur-F strain Bacillus Calmette-Guérin (BCG) on bladder carcinoma was studied in 39 patients. Multiple recurrent superficial transitional cell carcinoma was present in 36 cases, including 11 with concomitant carcinoma in situ (CIS), and primary CIS in three. The mean age of the 27 men and 12 women was 72 years. A 6-week induction course was given, beginning usually 4-6 weeks after transurethral tumor resection (TUR) or random biopsies, with periodic followup cystoscopies and cytologic analyses. A second 6-week course was given only to patients with incomplete response (positive urinary cytology or recurrent tumor). Three patients received maintenance intravesical BCG. If there was no response at the first cystoscopy after the induction course, no further BCG was given. Side effects were mostly local, moderate and transient, subsiding spontaneously or responding to symptomatic treatment. Severe systemic side effects occurred in three patients. Two with arthritis/arthralgia were managed as out-patients, while one with BCG pneumonitis/hepatitis required hospitalization, triple antituberculosis medication, cloxacillin and prednisolone. Complete response, defined as negative cystoscopy, cytology and histology, was obtained in 11 of 21 cases of papillary carcinoma without concomitant CIS. These patients were followed up for 8-47 months. Of the ten non-responders, two died and eight underwent further TUR. Of the 11 patients with concomitant CIS, six showed complete and five no response. Two of the latter died and three had further TUR. In all three cases of primary CIS there was complete response.
Administration, Intravesical↗
The detubularized right colonic segment as urinary reservoir: evolution of technique for continent diversion.
Continent diversion of urine via a cecal-right colonic reservoir has been performed at our university hospital since 1977. Several modifications of surgical technique have been devised to prevent problems of urinary leakage and difficulties in catheterization. The current technique, used during the last 3 years on 14 patients, involves use of a detubularized right colonic segment as a reservoir, ileal mesenteric exclusion, fashioning the intussuscepted ileal nipple valve with staples and anchoring of a fascia strip sling around the nipple base to the anterior rectus sheath. Complication from the reservoir outlet occurred in only 1 patient.
Cecum↗
Experience with a detubularized right colonic segment for bladder replacement.
A detubularized right colonic segment was used as bladder substitute in ten men who underwent cystoprostatectomy for carcinoma of the bladder. Postoperative complications unrelated to the replacement procedure occurred in three cases. Stricture of the urethrocaecal anastomosis developed during follow-up in one case. Day-time continence with convenient micturition intervals was achieved in all cases. Nocturnal continence was also maintained if the patients awoke once or twice to void. Urodynamic studies revealed adequate capacity, little or no residual urine and pressure waves of low amplitude at high-level filling. The technique employed for creation of a bladder substitute offers the advantage of technical simplicity. The bowel it utilizes is of secondary importance for intestinal absorption, and the result is a low-pressure, capacious neobladder.
Adult↗
Cystic dilatation of Cowper's gland duct--an overlooked cause of urethral symptoms?
Dilatation of Cowper's gland duct was diagnosed in four men with symptoms including post-voiding dribbling, frequency of micturition, dysuria and hematuria. Cystourethrography gave the correct diagnosis in all cases. Treatment consisted of transurethral incision of the cystic excretory duct, providing marsupialization into the urethra. Investigation of longstanding or recurrent episodes of urethral symptoms in men should include cystourethrography with this lesion in mind. It seems to be less rare than was previously assumed.
Adult↗
Urine from continent caecal reservoirs. Studies on chemical composition and bacterial growth.
The composition of urine from 11 patients with continent caecal reservoir was examined with regard to promotors and inhibitors of bacterial growth, and was compared with that of urine from individuals (controls) with intact urinary tracts. Reservoir urine was found to have a higher and less variable pH than control urine. The concentration of urea was lower in reservoir urine, probably due to the larger 24-hour urinary output, while the concentration of albumin was higher. Although these findings could suggest reservoir urine to be a more favourable medium for bacterial growth than normal urine, such a difference was not found in growth studies of common urinary pathogens. The increased prevalence of urinary tract infection in patients with caecal reservoir may be due to contamination on catheterization, residual urine and defective function of the reservoir outlet rather than differing qualities of the urine.
Adult↗
Continent urinary diversion by means of a cecal reservoir.
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Adult↗
Lewis blood group antigens in urine sediments from patients with urinary bladder carcinoma.
Urine sediments from 20 patients with urinary bladder carcinoma, and from 11 healthy individuals were investigated for their content of Lea and Leb active glycolipids. The investigation was restricted to blood group phenotype Le (a-b+). All individuals exhibited both Lea- and Leb-active glycolipids. In healthy individuals the ratio Lea/Leb was less than 1 in 10 out of 11 cases, whereas in patients with bladder cancer the ratio Lea/Leb was greater than 1 in 11 out of 20 cases. No correlation between the Lea/Leb ratio on the one hand and tumour grade or stage on the other hand could be shown. The results indicate one possible explanation for the loss of ABH antigens in bladder cancer and also demonstrate the potential of detailed biochemical investigations on exfoliated material in urine.
Carcinoma, Transitional Cell↗
The continent cecal reservoir for urine.
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Adult↗
The microbial flora of the continent cecal urinary reservoir, its stoma and the peristomal skin.
The bacteria occurring in reservoir urine, on the cutaneous stoma and on the abdominal skin were studied in 9 patients who had undergone urinary diversion via a continent cecal reservoir. Aerobic and/or facultatively anaerobic bacteria were isolated persistently from reservoir urine in 3 patients but only occasionally in the remainder. These organisms were isolated in pure culture. Anaerobic bacteria also were found, although infrequently and only in conjunction with facultative anaerobes. Most stomal cultures showed heavy growth of Staphylococcus epidermidis, while fewer microbes were isolated in the abdominal skin cultures. Propionibacterium acnes, present in most skin cultures, was absent or scantily represented on the stoma. Microbial antibiosis was demonstrated in vitro between stomal and urinary reservoir bacteria in 6 patients. However, bacteria from stomal isolates had no antagonistic effect against bacteria belonging to the family of Enterobacteriacae or against anaerobic species isolated from urine. Antibiosis may influence the microbial ecology of the urine reservoir and cutaneous stoma.
Adult↗
Cardiovascular complications of estrogen therapy for nondisseminated prostatic carcinoma. A preliminary report from a randomized multicenter study.
In a prospective multicenter study, 244 men with highly or moderately differentiated prostatic cancer in stage I, II or III (VACURG) were consecutively randomized to three groups of treatment: Group A (77 patients) received polyestradiol phosphate (Estradurin, Leo) 80 mg i.m. every fourth week + ethinyl estradiol (Etivex, Leo) 150 micrograms daily, group B (72 patients) estramustine phosphate (Estracyt, Leo) 280 mg twice daily, and group C (76 patients) no therapy. Only men without current or previous other malignancy and without cardiovascular disease were admitted to the study. After 4 1/2 years 125 of the 244 patients had left the study, 9 because of cancer progression (stage IV, VACURG). The most serious complications were cardiovascular, including ischemic heart disease, cardiac decompensation, cerebral ischemia and venous thromboembolism, which occurred in 24 patients from group A and 9 from group B as compared to only one patient in group C. The subgroup superficial or deep venous thrombosis comprised 11 group A and 2 group B patients. Estrogens (E + e) offered as palliative treatment to patients with non-generalized prostatic carcinoma is burdened with a high incidence of serious cardiovascular complications.
Aged↗
Immunoglobulins in urine from patients with ileal and colonic conduits and reservoirs.
Gel chromatography of proteins in urine from continent cecal urinary reservoirs revealed an abundance of high molecular weight proteins, especially secretory immunoglobulin A. Quantitation of immunoglobulins in urine from ileal and colonic conduits and ileal and cecal reservoirs showed secretory immunoglobulins A, G and M in amounts considerably greater than in urine from normal urinary tracts, whether or not bacteriuria was present. More secretory immunoglobulin A was found in reservoir than in conduit urine, but there was no such difference for immunoglobulin G and immunoglobulin M. In hemagglutination-inhibition tests, immunoglobulin A antibodies from cecal reservoir urine in 1 patient inhibited adherence (mannose-resistant) to human and animal erythrocytes of Escherichia coli obtained from reservoir urine from that same patient. High levels of secretory immunoglobulin A may constitute a host defense mechanism against urinary tract infection in patients with reservoirs and conduits.
Adult↗
Continent caecal reservoir in urinary diversion.
Construction of a continent urinary reservoir was attempted in 18 patients with carcinoma of the bladder. The caecum was used as the reservoir and an intussuscepted ileal nipple was created to provide continence. Fifteen patients are alive and have been observed for 7 to 68 months. The most common complication was malfunction of the nipple valve with urinary leakage and/or difficulty in catheterisation. Revision of the outlet was performed one or more times in 11 cases. The technique of nipple valve construction was successively evolved, with improvement in the functional results. Stricture of one uretero-intestinal anastomosis occurred in three patients. Construction of a continent caecal reservoir is a complex procedure and the problem of a stable, continence-ensuring mechanism in the outlet has not been conclusively solved. The enhanced quality of life offered by a successful continent reservoir nevertheless warrants continued clinical trials in selected patients.
Adult↗
Renal function after urinary diversion. A study of continent caecal reservoir, ileal conduit and colonic conduit.
Total and separate renal function, renal parenchymal thickness and dilatation of the upper urinary tract were studied in 40 patients preoperatively and 24 to 67 months after urinary diversion, using 51Cr-EDTA clearance test, scintillation camera renography and urography. In ten patients a continent caecal reservoir was used for diversion. In the other patients, an ileal or a colonic conduit (15 patients with each method) was used, one ureter being implanted with an anti-reflux method and the other with direct technique. Renal function following urinary diversion showed little or no deterioration in most patients. The functional outcome was not related to the method of diversion or, in the conduit groups, to the mode of ureteral implantation. Serum creatinine tests and urography were not adequate for determining loss of renal function. Radionuclide studies proved to be valuable for assessing renal function after urinary diversion.
Adult↗
A histochemical and ultrastructural study of human urethral uroepithelium.
The ultrastructure and histochemistry of the human urethral mucosa was studied. By scanning electronmicroscopy (SEM) the cover cell of the urethra was found to be polygonal and with a surface topography characterized by numerous microvilli and micro-ridges. By transmission electronmicroscopy (TEM) the cover cells were shown to be interconnected with tight junctions but to lack the asymmetric luminal membrane and the fusiform vacuoles that characterize urothelium above the bladder neck. Histochemical analyses showed the human urethral cells to harbour large amounts of glycogen, and the glycocalyx facing the urethral lumen displayed high affinity for alcian blue and colloidal iron, indicating the presence of acid mucopolysaccharides. The reactivity with alcian blue appeared at pH 2.5, but was abolished by pre-treatment with sialidase. Studies with TEM or using SEM with energy-dispersive X-ray spectrometry (EDX) confirmed the high content of acid mucopolysaccharides in the luminal glycocalyx of the cover cells by demonstrating high binding capacity for ruthenium red. The quantitative binding of ruthenium red was not influenced by pH shifts between 4.5 and 7.5. Utilizing the SEM + EDX technique, small variations in quantity of negative charge (i.e. of bound ruthenium red) were detected within individual cover cells, but considerable variations were found between cells. The significance of these physicochemical properties of the human urethral lining is discussed with special reference to the previously demonstrated liability of this mucosal surface to interact with microorganisms such as Escherichia coli, Staphylococcus saprophyticus and Neisseria gonorrhoeae.
Cell Membrane↗
Inhibitory effect on the formation of chlamydial inclusions in McCoy cells by seminal fluid and some of its components.
Our purpose was to determine the effect of semen and some of its components upon chlamydial inclusion (CI) count and cytopathogenic effect in cycloheximide-treated McCoy cells. Semen and spermine caused a dose-related decrease in the number of CI, using a standardized infectious dose of Chlamydia trachomatis, immunotype F. Lysozyme in certain concentrations stimulated CI formation, whereas the cations Cu++ and Zn++ produced a cytopathogenic effect and a dose-related reduction of the CI count, EDTA neutralized the effects of the cations and its addition to seminal fluid experimentally infected with C. trachomatis resulted in a greater number of CI than found in control cultures containing only semen.
Adult↗
[Urinary tract infections caused by coagulase negative Staphylococcus].
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Adolescent↗
Surface properties of Staphylococcus saprophyticus and Staphylococcus epidermidis as studied by adherence tests and two-polymer, aqueous phase systems.
S. saprophyticus is an established pathogen in man, devoided of characteristics associated with pathogenicity in Staphylococcus aureus. The ability of this species to attach to cells from regions, viz. the urinary tract, where it acts as an invador and to cells from areas where it is known as a commensal, was compared to its behaviour in this respect with another staphylococcal species, viz. S. epidermidis. S. saprophyticus showed a preferenital adherence to human exfoliated urogenital cells, when compared with its ability to attach to skin and buccal cells from man and also when compared with procine cells from these regions. The profound ability to adhere to human exfoliated urogenital epithelial cells by far exceeded that of S. epidermidis, while no such species difference was found when testing porcine cells (S. saprophyticus is unknown as a urogenital tract pathogen in pigs). When studied in a two-polymer, aqueous phase system, S. saprophyticus and S. epidermidis were found to have a negative surface charge at pH 7.2, but the former carried a considerably higher surface charge density. Both staphylococcal species exhibited a poor hydrophobic interaction liability. These physico-chemical surface characteristics are briefly discussed with regard to the differential bacteria-cell interactions of these species.
Adhesiveness↗