Biomedical subjects
Publications and source records attributed to S Vaidyanathan.
Following emergency cavernospongiosum shunt performed for priapism occurring in a psychiatric patient on chlorpromazine therapy, a urethro-caverno-cutaneous fistula with distal urethral stricture developed, resulting in aberrant voiding into the corpora cavernosa. The causation, management, and prevention of this hitherto unreported combination are discussed.
Beta-adrenergic activity of the proximal urethra was studied in 11 patients. Maximum urethral pressure was recorded before, and 20 and 60 minutes after the intravenous administration of 0.5 mg. orciprenaline sulfate. There was a 40 per cent or more decrease in the maximum urethral pressure in 6 of the 11 patients. Beta-adrenoreceptor agonists could prove useful in facilitating vesical emptying by reducing urethral resistance in patients with neurogenic bladder dysfunction.
Beta-adrenergic activity in the proximal urethra was studied in 15 patients with neurogenic bladder dysfunction owing to spinal cord injury or to neurogenic disease. Maximum urethral closure pressure was recorded before and after the administration of terbutaline, a beta-2 agonist. The average decrease in maximum urethral closure pressure after subcutaneous injection of terbutaline was 40.46 per cent and this was significant (p less than 0.001). The clinical implications of this finding are discussed.
Clonidine, a centrally acting hypotensive agent was shown to decrease peak urethral pressure and facilitate vesical emptying in patients with neurogenic bladder dysfunction due to low spinal lesion. Selection of patients, side effects of therapy, and its mode of action are discussed.
When a scrotal affection cannot be diagnosed confidently by correlation of clinical history and physical examination, testicular scanning with 99mTc is a useful adjunct diagnostic modality. In vivo labelling of red blood cells with 99mTc was achieved by prior oral administration of 200 mg of stannous chloride. This helped to obtain satisfactory scintigraphy with a rectilinear scanner. This procedure was found to be useful in the adult with recent tender testicle in whom the torsion of the testis could not be clinically differentiated from epididymo-orchitis. Another area of scan's valuable clinical application was in the early diagnosis of testicular abscess in patients with epididymo-orchitis not responding immediately to antibiotic therapy. The study also proved to be a useful, non-invasive method for follow-up assessment of a case of torsion of the testis where detorsion and orchiopexy was performed as well as in case of rupture of a testis after orchiorrhapy.
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The effect of intravenous administration of 20 mg metoclopramide, a dopamine receptor antagonist upon cystometry, urethral pressure profile and external urethral sphincter electromyography (EMG) was investigated in 10 patients with neurogenic bladder dysfunction. No significant change was noticed in detrusor reflex activity or in peak urethral pressure. This suggests that dopamine receptors are not important in vesicourethral function. The increase in sphincter EMG activity observed was probably due to the cholinergic effect of metoclopramide.
The effect of intravenous administration of 5 mg of haloperidol, a dopamine receptor antagonist upon cystometry, the urethral pressure profile, and the external urethral sphincter electromyography (EMG) was investigated in eight patients with neurogenic vesical dysfunction. There was no change in the detrusor reflex or in the sphincter EMG activities, but the peak urethral pressure decreased. The possible reasons for the difference in the above result as compared to our previous study using metoclopramide, another dopamine receptor antagonist, are discussed.
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Two cases are reported of spontaneous rupture of pelvic hydatid cysts into the bladder, which were managed conservatively. The resulting communication between the bladder and the cyst was used advantageously for intravesical instillation of 20% saline to destroy the germinal layer of the hydatid cyst and daughter cysts. Sequential cystographic studies showed disappearance of the extrinsic pressure effect on the bladder as the daughter cysts were evacuated repeatedly per urethram after instillations. Spontaneous sealing off of the communication was documented and confirmed by cytoscopy in 1 case. A plea is made to adopt a non-operative approach in such cases, which permits intravesical and, hence, intracystic scolecidal agent instillation and achieves spontaneous evacuation of daughter cysts. Other factors encouraging conservative management whenever possible are the reportedly high recurrence rate of hydatid cysts postoperatively, the morbidity described with complete excision of pelvic and other hydatid cysts, and the inherent slow process of recurrence (between 5 and 20 years) after complete evacuation of daughter cysts.
A female paraplegic developed intraperitoneal rupture of urinary bladder seven weeks after institution of indwelling urethral catheter drainage. Blockage of the catheter precipitated this fatal event. Oliguria after an initial encouraging urinary output despite adequate fluid replacement led us to suspect bladder rupture which was confirmed by urgent cystography. Although emergency laparotomy to repair the rent in the bladder was performed, she succumbed to gram-negative septicemia. Other hazards of indwelling urethral catheter drainage even for short periods are highlighted (though the above complication itself is admittedly rare) with an oft re-emphasised plea to consider earlier the alternative modality of intermittent catheterisation or pharmacotherapy in female patients.
The importance of vaginocystography as an additional tool to excretory urography and cystoscopy in assessment of vesicovaginal fistulae is emphasized. A simple technique applicable even to large and multiple fistulae or a capacious vagina is described and discussed.
A case of spontaneous rupture of the renal pelvis during postobstructive diuresis following spontaneous relief of anuria in a patient with postpyelolithotomy retroperitoneal fibrosis, is described. The unusual etiopathological setting which predisposed to the occurrence of such a rare phenomenon and its treatment implications are discussed.
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Fatal acute tubular necrosis occurred in 1 patient in whom intravesical formalin was used to control massive persistent hemorrhage from radiation cystitis. A suggestion is made to monitor blood formic acid levels and institute prompt dialysis whenever these exceed 80 mg. per 100 ml. to avert such a catastrophe. Intravenous sodium bicarbonate appears to be indicated prophylactically in combating the associated metabolic acidosis due to absorbed formic acid.
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Of 51 patients with detrusor-sphincter dyssynergia undergoing external urethral spincterotomy by transurethral resection, histological examination revealed no skeletal muscle in the resected tissue in six patients. The functional improvement which resulted in these cases despite this finding with an explanation for the same forms the topic of this paper.
Infusion pyelography was performed in 103 anuric patients with no attendant mortality. It was useful in 83 cases in distinguishing obstructive uropathy from renal parenchymal disease. However, in the remaining 20 cases when either renal parenchymal disease co-existed with obstructive uropathy or obstructive uropathy existed alone under certain circumstances, opacification of the collecting system did not occur. The clinicopathological setting of some of the latter group of cases is illustrated by examples.