Search PubMed⌕ Search

Biomedical subjects

S Juma

Publications and source records attributed to S Juma.

35 records · Page 2Linked to original sources
PubMed1993

Magnetic stimulation of the sacral roots.

Magnetic stimulation using an external surface coil induces an electrodynamic field that penetrates various tissues and stimulates peripheral nerves in a similar fashion to conventional electrical stimulation. An 83 mm magnetic surface coil was used to stimulate 11 spinal cord injury (SCI) patients, during which time detrusor activity and evoked potentials of the striated urinary sphincter motor pathways were evaluated. All patients had urodynamic studies and conventional sacral evoked potentials prior to magnetic stimulation. The mean bladder capacity was 337 ml (range 109-590), mean leak point pressure was 50 cm H2O (range 10-80), and mean sacral reflex (afferent-efferent) latency was 37.9 ms (range 25.1-49.3). Eight patients had detrusor-sphincter dyssynergia. Magnetic stimulation over the sacral spine at different bladder volumes was performed. Detrusor and striated sphincter responses were recorded during stimulation. In all patients the technique was easy and the results were reproducible. The mean sacral motor pathway (efferent) latency was 27.9 ms (range 18.7-39.6). Using maximal stimulation, no detrusor response was recorded at bladder volumes < 200 ml. However, a detrusor response was recorded in 7 patients (> 10 cm H2O in 2, < 10 cm H2O in 5) when the bladder volume was > 200 ml. No complications were seen. Sacral evoked potential measurements assess the function and integrity of the sacral arc but it does not distinguish between afferent and efferent pathways. Magnetic stimulation is a safe and effective method to assess the integrity and function of the detrusor and striated sphincter motor (efferent) pathways. When combined with sacral evoked potential studies, the sensory (afferent) pathways can be evaluated indirectly.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Prolongation of response to DMSO by heparin maintenance.

Dimethylsulfoxide (DMSO) is an effective treatment of symptomatic patients with detrusor mastocytosis but it is associated with frequent relapses. A group of patients (N = 25) followed for twelve months showed a relapse rate of 59 percent. Our experience with a combination of DMSO and heparin has suggested that the relapse rate may be lower. Heparin is a glycosaminoglycan that may afford protection to the urothelium and may reduce the relapse rate. It is better tolerated than DMSO or a combination of DMSO and heparin and does not produce garlic halitus. It is not associated with coagulation anomalies when administered intravesically. To determine whether or not maintenance therapy with intravesical heparin may reduce relapses we have treated a similar cohort of 25 patients with monthly instillations of 10,000 IU of heparin over a twelve-month period. Both groups were comparable in age, duration of symptoms, severity of symptoms, and response to DMSO. At twelve months only 20 percent of the heparin-treated group had relapsed versus 52 percent of the control group. Furthermore 6 patients (24%) in the follow-up group failed to respond to retreatment with DMSO while all of the heparin maintenance group continued to respond to one or more treatments with DMSO. Thus, it seems that heparin maintenance produces a significant reduction in the relapse rate of patients who respond to DMSO and reduces the number of patients requiring alternative therapy.

Administration, Intravesical↗
PubMed1993

Transrectal ultrasound urodynamics.

Seventy-seven male patients (34 with cervical spine injury, 32 with thoracic spine injury, 9 with lumbosacral spine injury, and 2 with multiple sclerosis) who were referred to our spinal cord injury unit for urologic evaluation had videourodynamic studies using transrectal ultrasound and fluoroscopy. All were studied twice in the same session: first with transrectal ultrasound urodynamics (TRUSU) and the second time with conventional fluoroscopic videourodynamics (VUD). The findings were compared. Efficacy of TRUSU: (1) clearly documented flow of fluid through bladder neck into posterior urethra before clinical leakage occurred per urethra; (2) allowed accurate placement of EMG needle electrodes in external urinary sphincter under visual guidance; (3) provided high-quality imaging of surrounding structures and allowed assessment of bladder neck, prostate, seminal vesicles, and posterior urethra; (4) eliminated radiation exposure to the patient and the examiner, with no time limit imposed on imaging so that repeat studies could be done to evaluate patients on new drug treatments or postoperatively at no increased risks; and (5) its availability to most urologists at their office at considerably less cost to set up than fluoroscopy. In our study TRUSU identified a hypoechoic lesion in the prostate of 1 patient and a tumor in the bladder neck of another patient. Fluoroscopic VUD identified 6 patients with bladder diverticula and 2 with grades 1 and 2 vesicoureteral reflux which TRUSU did not identify. Our experience indicates TRUSU is a valid and preferable alternative to fluoroscopic VUD for patients with spinal cord injury.

Adult↗
PubMed1992

Vaginal wall sling: four years later.

Since December 1985, we have treated 65 patients with urinary stress incontinence due to intrinsic sphincter dysfunction with the vaginal wall sling procedure. Of the 54 patients who were available for follow-up, intrinsic sphincter dysfunction was related to multiple prior bladder neck suspension procedures in 48 patients. In the remaining 6 patients, 2 had pelvic trauma, 2 had neurogenic urethral dysfunction, 1 had urethral diverticulectomy, and 1 had pelvic radiation. The success rate of the vaginal wall sling procedure for correcting stress incontinence was 94.4 percent at a mean follow-up of 23.9 months. Postoperative complications were minimal. Although 83 percent were temporarily in urinary retention, in the absence of neurogenic bladder and augmentation cystoplasty, only 5.5 percent needed intermittent self-catheterization on a long-term basis. De novo detrusor instability developed postoperatively in 14.8 percent of the cases. In no patient did a vaginal inclusion cyst develop. The vaginal wall sling is a simple procedure with excellent success rate and minimal morbidity. We recommend it for patients with stress urinary incontinence due to intrinsic sphincter dysfunction.

Adult↗
PubMed1992

Levator hernia.

We report a case of a hernia through the pelvic floor presenting as a paravaginal mass following a transvaginal fascial sling procedure. At exploration herniation through a defect in the pelvic floor was identified and repaired. To our knowledge this is the first reported case of levator hernia. The clinical and radiological findings and anatomy are presented, and treatment recommendations and etiology are discussed.

Aged↗
PubMed1991

In vivo characterization of the inflammatory properties of poly(tetrafluoroethylene) particulates.

Suburothelial injections of particulate poly(tetrafluoroethylene) (PTFE) is becoming a widely accepted treatment for a number of urological disorders. Because little is known about the long-term histologic morphology of the injection site, this animal study was performed. Three populations, each consisting of two mongrel dogs, five New Zealand White rabbits, and 10 BALB/c mice, were injected with poly(tetrafluoroethylene) particulate in a glycerine carrier (Polytef Paste) and were followed for a period of 1 week, 3 months, 6 months, and 1 year. Mice received one subcutaneous dorsal injection each, rabbits received two subareolar injections each, and dogs received three subareolar injections each in addition to two periurethral injections. Histologic examination of the biopsy sites revealed a persistent chronic inflammatory reaction with progressive growth of the involved tissue volume. In addition to giant cells and macrophages, lymphocytes became apparent at 3 months and constituted up to 40% of the cellular infiltrate by 1 year. Plasma cells were also noted at the 1-year period in the rabbit model. The progressive growth of the inflammatory pseudo-tumors evoked by injected PTFE may compromise the long-term safety of certain urological procedures involving particulate PTFE.

Acute Disease↗
PubMed1991

Repair of severe anterior vaginal wall prolapse (grade IV cystourethrocele).

The classical approach for the repair of severe anterior vaginal wall prolapse is the use of transvaginal colporrhaphy or, more recently, an abdominal paravaginal repair. Severe cystoceles develop from weaknesses of the levator sling and pubocervical fasciae resulting in 2 main anatomical changes: a central defect between the pubocervical fasciae, and a sliding herniation of the bladder and urethra (paravaginal defect). We developed a new transvaginal technique for the repair of large cystoceles (grade IV) extending outside of the introitus at rest, which includes repair of the central defect by anterior colporrhaphy, and repair of the paravaginal herniation of the bladder base and bladder neck by a needle suspension of these structures. We report our experience within a 5-year period in the treatment of 51 cases of severe bladder prolapse (grade IV cystoceles), 46 of which required this combined procedure regardless of preoperative stress urinary incontinence status. Five patients underwent anterior colporrhaphy as the only procedure, since they were continent and demonstrated a well supported bladder neck from a previous suspension operation. Other vaginal abnormalities should be repaired simultaneously to provide adequate pelvic floor support.

Adult↗
PubMed1990

Spontaneous subcapsular hematoma in an ectopic kidney.

An unusual case of spontaneous rupture of the kidney is presented. We believe this to be the first reported case of spontaneous subcapsular renal hematoma in a kidney that is crossed-ectopic (pelvic) and hydronephrotic.

Adult↗
PubMed1990

Appendix interposition of the ureter.

Under specific circumstances the appendix vermiformis may be an appropriate organ for plastic repair of a large ureteral defect. We report a situation in which all of the criteria were met and in which a long ureteral defect was bridged successfully with the appendix.

Aged↗
PubMed1990

The mechanisms of continence in the Indiana pouch: a video-urodynamic study.

The ileocecal reservoir (Indiana pouch) is a large volume, low pressure continent reservoir well suited for urinary diversion. The mechanism of continence is believed to be the result of several factors, including the natural ileocecal valve resistance, resistance produced by the plication of the ileal segment and normal peristalsis of the ileum. We report the results of a video-urodynamic study in patients with an Indiana pouch, aimed at establishing the factors that contribute to continence and their relative significance. Video-urodynamic studies clearly demonstrate that continence in this type of urinary reservoir is dependent upon a synergism of the aforementioned factors in combination with the low intraluminal pressure of the detubularized bowel. Video-urodynamic studies offer an objective demonstration of the reservoir dynamics and its continence mechanisms, and provide an insight into the possible etiology of incontinence. Such studies also offer an objective means for critical comparison of the different continent urinary reservoirs.

Contrast Media↗
PubMed1990

Basic evaluation of female urinary incontinence.

Urinary incontinence is a common disorder that is frequently underreported because of its social implications. Although several types of urinary incontinence are recognized, they can be generally classified as failure of the bladder to store or failure of the urethral mechanism. A systematic approach for the evaluation of incontinence that includes history, physical examination, basic laboratory tests, and often urodynamic evaluation, offers the most comprehensive assessment of the etiology of incontinence.

Aged↗
PubMed1989

Carcinoids of the kidney: case report and literature review.

Primary carcinoids of the kidney are very rare, only 10 cases having been reported in the literature. The authors report a case of primary renal carcinoid in a 50-year-old woman. A radical nephrectomy with lymphadenectomy was successfully performed and there was no residual or recurrent tumour at 2-year follow-up. A review of the reported cases revealed a variable, nonspecific presentation. Most laboratory tests were non-contributory except for urinalysis. When a renal carcinoid is diagnosed, a search should be made for a possible primary elsewhere. Primary renal carcinoid does exhibit malignant behaviour. It should be managed by radical nephrectomy with retroperitoneal lymphadenectomy.

Carcinoid Tumor↗
PubMed1987

Urodynamic studies in interstitial cystitis.

Urodynamics, although not diagnostic of IC, are useful in the differential diagnosis of painful voiding disorders and provide a convenient way to quantitate response to therapy. They may prove useful as prognostic indicators of response to treatment and are of value in those patients in whom surgery is considered. Our studies suggest that IC is a progressive disease if not treated and that early diagnosis may improve response to treatment. Although similar information can be gathered by other means, we find urodynamics reliable, reproducible, and quantifiable and a valuable tool in the diagnosis, treatment, and follow-up of patients with IC.

Cystitis↗
PubMed1985

Lymphomatous intracardiac mass detected by radionuclide ventriculography.

A case of non-Hodgkin's lymphocytic lymphoma with cardiac involvement shown as an intracardiac-filling defect on the radionuclide ventriculogram is presented. The non-invasive diagnostic methods for cardiac lymphoma work-up are discussed. The known causes of cardiac-chamber filling defect(s) are reviewed.

Adult↗