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Biomedical subjects

T Hald

Publications and source records attributed to T Hald.

At least 73 records · Page 4Linked to original sources
PubMed1987

Urinary excretion of a metabolite of histamine (1,4-methyl-imidazole-acetic-acid) in painful bladder disease.

Thirteen patients with interstitial cystitis (detrusor mastocytosis) and 12 other patients with painful bladder disease without mastocytosis collected 24-h urine specimens that were analysed for the major metabolite of histamine, 1,4-methyl-imidazole-acetic-acid (1,4-MIAA), by reversed phase ion-pair high performance liquid chromatography. The median urinary excretion of 1,4-MIAA was 3.34 mg/24 h (range 1.47-4.66) in the patients with detrusor mastocytosis and 1.75 mg/24 h (range 0.18-4.30) in the other patients with a painful bladder (P less than 0.01). It was concluded from this study that patients with a painful bladder and detrusor mastocytosis had a significantly elevated urinary excretion of 1,4-MIAA compared with other painful bladder patients without mastocytosis, whose urinary excretion of 1,4-MIAA was within the normal range (0.72-2.34 mg/24 h). We suggest that the urinary excretion of 1,4-MIAA might be useful in the diagnosis of interstitial cystitis.

Cystitis↗
PubMed1987

Pathogenesis of nocturnal urinary incontinence after ileocaecal bladder replacement. Continuous measurement of urethral closure pressure during sleep.

Urethral closure pressure was recorded in four patients during sleep in order to determine the pathogenesis of nocturnal incontinence after radical cystectomy and ileocaecal bladder replacement. The sleep stages were determined by electroencephalography. The resting pressure in the intestinal bladder was low and increased only slightly during filling. The maximum urethral pressure decreased during sleep but the urethral closure pressure remained positive when the intestinal bladder was not contracting. The peristaltic contractions in the intestinal bladder continued during sleep, causing incontinence. The nocturnal incontinence is probably a result of the reduced level of consciousness that makes it impossible to increase the tone of the external urethral sphincter during contractions of the intestinal bladder.

Electroencephalography↗
PubMed1987

Vasoactive intestinal polypeptide concentration in human bladder neck smooth muscle and its influence on urodynamic parameters.

Three human studies were performed to evaluate the influence of vasoactive intestinal polypeptide (VIP) on bladder and urethral function. Bladder neck smooth muscle biopsies were obtained from nine men with functional bladder neck obstruction, from 10 men with medium sized benign prostatic hypertrophy and from four patients with a normal infravesical outlet. The biopsies were analysed for VIP by radioimmunoassay and by immunohistochemistry. No differences were found between the groups. Pressure-flow-EMG studies were performed in five men and urethrocystometry was performed in six women at rest, repeated coughing and at squeezing before, during and after VIP 3 micrograms/kg X h intravenously. No systematic changes developed in any of the urodynamic parameters.

Adult↗
PubMed1987

Surgery for urologic complications following radiotherapy for gynecologic cancer.

Urologic surgery was necessitated by complications following radiotherapy for gynecologic cancer in 17 patients. Four had recurrent malignant disease and 13 were without evidence of malignancy. The median interval to onset of the urologic complications was 18 (range 0-144) months. Ileal substitution was performed because of bilateral ureteral obstruction in two cases, and transureteroureterostomy for unilateral obstruction in one case. Vesicovaginal fistula was present in 14 patients, who underwent urinary diversion--cutaneous ureterostomy and ligation of the other ureter (6 cases), cutaneous ureterostomy and transureteroureterostomy (3) and ileal conduit diversion (5). The immediate morbidity and mortality were determined by the patients' general state of health rather than by presence or absence of recurrent malignant disease. The choice of diversion procedure should be guided by the patient's fitness, the status regarding recurrence of malignancy and the distribution of function between the two kidneys.

Adult↗
PubMed1986

Carcinoma in situ of contralateral testis in patients with testicular germ cell cancer: study of 27 cases in 500 patients.

Carcinoma in situ in the contralateral testis was diagnosed in 27 of 500 patients (5.4%) with unilateral testicular germ cell cancer. Eight of the 27 patients received intensive chemotherapy for spread of their initial testicular cancer. Follow up biopsy studies did not detect changes of carcinoma in situ in any of these patients, and none developed a contralateral testicular tumour (observation time 12-88 months). Of the remaining 19 patients with carcinoma in situ, seven developed contralateral testicular cancer. The estimated risk of developing invasive growth was 40% within three years and 50% within five years. None of the 473 patients without carcinoma in situ detected by screening biopsy developed contralateral testicular cancer (observation time 12-96 months). No serious complications arose from the biopsy procedures. All patients with unilateral testicular germ cell cancer should be offered biopsy of the contralateral testis.

Adult↗
PubMed1986

Electron microscopic investigation of the bladder urothelium and glycocalyx in patients with interstitial cystitis.

The electron microscopic appearance of the bladder urothelium and glycocalyx was investigated in ten patients with well defined interstitial cystitis and compared to the findings in ten control patients with stress incontinence as the only symptom. Ruthenium red, a polycationic dye which binds specifically to cell surface acid polysaccharides, was used to demonstrate the glycocalyx. In cases of interstitial cystitis two types of luminal cell were observed, each possessing a distinct surface glycocalyx. One type of cell possessed numerous plaques of asymmetric unit membrane associated with a relatively thin glycocalyx. The second type of cell was characterised by numerous microvilli and a relatively thick glycocalyx. In control material each type of cell and its associated glycocalyx was identified with similar frequency. Our study concludes that there are no differences in the morphologic appearances of the glycocalyx and of urothelial cells in patients with interstitial cystitis when compared with controls. Hence, the hypothesis that an important pathogenic factor in interstitial cystitis is a defective glycocalyx associated with a permeable urothelium, has not been supported.

Adult↗
PubMed1986

Terodiline in the treatment of women with urgency and motor urge incontinence. A clinical and urodynamic double-blind cross-over study.

In a consecutive double-blind cross-over study, 18 females with detrusor instability were treated with an anticholinergic and calcium antagonistic agent terodiline 25 mg bid or placebo for 3 weeks; cross-over took place after a wash-out period of 1 week. The efficacy of the drug was investigated at the end of each treatment period by means of drug preference, micturition charts, pad usage, bladder and urethral mucosal perception threshold and bulbocavernosus reflex latency measurement. Serum levels of terodiline were estimated at the end of each treatment period and all side effects were reported. The preference for the drug was statistically significant (P less than 0.01): 14 patients preferred the drug, one preferred the placebo and three had no preference. A small but statistically significant reduction was found in 24-h micturition frequency (P less than 0.05). Cystometry showed an increase in volume at first sensation, an increase in volume at detrusor contraction and a tendency towards an increase in bladder capacity, whereas detrusor contraction pressure was unchanged. Median serum levels of the drug were 559 ng/ml (range 203-1117). No serious side effects were reported. It was concluded that terodiline should be considered as an alternative drug in the treatment of motor urge incontinence.

Adult↗
PubMed1986

Coecocystoplasty: an evaluation of operative results.

Coecocystoplasty for substituting or augmenting the bladder is a relatively common operation in the United States, but not in Scandinavia. In order to focus the attention on this voiding-preserving operation we evaluated the late postoperative results of 8 patients. Median follow-up was 5 years. Seven of the patients had symptoms from a contracted bladder and 1 patient with epispadias was undiverted from a ureteroileocutaneostomy. There were some early postoperative complications. Two patients had a revision of the coecocystoplasty, 1 patient ended up with a ureteroileocutaneostomy and 1 patient needed a nephrectomy because of a perirenal abscess. The patient with epispadias later had an artificial urinary sphincter because of persisting incontinence. At follow-up time all patients found that they had a better life than prior to operation since the invalidating symptoms from the contracted bladder had disappeared. One patient with residual urine had chronic urinary tract infection. All patients were continent at daytime, 3 patients had nocturnal incontinence. Urodynamic studies showed no infravesical obstruction and bladder capacity between 75 and 380 ml H2O. Three patients had decreased renal function. Based on our limited material we conclude that coecocystoplasty is a reasonable, though not unproblematic, treatment in patients with severe symptoms from a small contracted bladder and a therapeutical alternative in patients with a previously defunctionalised bladder and that this method should always be taken into consideration before a urinary diversion.

Adult↗
PubMed1986

Pelvic floor exercise versus surgery for female urinary stress incontinence.

Fifty consecutive female patients with genuine urinary stress incontinence were randomized either to surgery or to a pelvic floor training program. The operative procedure was chosen according to the type of bladder suspension defect on micturition cystourethrography. The training program was given 5 times in weekly lessons and the patients were guided by trained physiotherapists. Surgery was superior to the pelvic floor training program both subjectively and objectively. However, a significant improvement was found following the training program. Forty-two percent were satisfied with the outcome of the training and did not want operation. We find physiotherapist-guided pelvic floor exercise a realistic alternative to surgery in patients with mild degrees of stress incontinence. Also patients with residual symptoms after surgery are candidates for pelvic floor training.

Adult↗
PubMed1986

Catheter-associated bacteriuria. A controlled trial with the Bardex Urinary Drainage System.

In a randomized trial, the Bardex Urinary Drainage System was tested against a routine system consisting of a silicone-coated 16F Latex Foley catheter and exchangeable 1 500 ml collecting bags. The Bardex system consists of an all-silicone balloon catheter preconnected and sealed to the drainage tube with tape. The tube is united with a 2,000 ml collecting bag via a vented drip chamber. It has an extremely hydrophilic coating (BN-74) resembling the natural glycosaminoglycans lining the urothelium. This coating is intended to minimize urethral irritation and bacterial migration and also to cause slow release of water-soluble antiseptics applied to the surface. In the present study, isobetadine 10% was applied prior to the insertion and reapplied daily after pulling gently on the catheter. Forty female patients aged 31 to 85 years completed the study. In the Bardex group of patients, bacteriuria developed in none by the third day of catheterization and in 5% by the fourth day. In the Foley group, the bacteriuria rate was significantly higher, with 35% on the third day (p less than 0.01) and 45% on the fourth day (p less than 0.02). No difference between the two drainage systems was found concerning incontinence beside the catheter, urethral pain or burning, meatal reddishness or urethral discharge. No conclusion regarding the advantages or disadvantages of the BN-74 coating and the isobetadine application can be drawn from the present study.

Adolescent↗
PubMed1986

Bladder training and terodiline in females with idiopathic urge incontinence and stable detrusor function.

Twenty consecutive female patients with urge incontinence and stable detrusor function on provocative rapid fill CO2-cystometry were treated as out-patients with a bladder training programme and with terodiline/placebo in a double-blind cross-over design. Frequency and incontinence episodes decreased significantly, while first sensation and cystometric bladder capacity increased. Both objectively and subjectively terodiline was significantly better than placebo with 50% (95% confidence limits 18-82) more patients improved on terodiline than on placebo. Thirty percent of the patients (95% confidence limits 12-54) relapsed after withdrawal of terodiline. At 3 months follow-up the remaining 70% were satisfied with the outcome of the training programme. Side effects were mild and reversible. Serum creatinine and alkaline phosphatase increased slightly on terodiline and the diastolic blood pressure was probably also increased by terodiline. In conclusion, female patients with idiopathic urge incontinence and stable detrusor function did respond to treatment as do female patients with urge incontinence and proven instability.

Adult↗
PubMed1986

The AMS artificial urinary sphincter on the bulbous urethra.

An artificial sphincter with the cuff on the bulbous urethra was implanted in 29 patients with urinary incontinence. After a median observation time of 3 years, 19 patients were continent, four others were improved and the system had been removed in six cases. Urethral erosion occurred in only two cases, both due to infection. Use of low-pressure systems is recommended.

Adolescent↗
PubMed1986

The use of the Boari-flap and psoas-bladder hitch technique in the repair of a high ureteric lesion. A case report.

Combining the bladder-psoas hitch Boari-flap technique makes it possible to replace the entire ureter. The operation was used successfully in one patient with an extensive proximal ureter lesion. This method can be used in patients with reduced renal function, since the continuity of the urinary tract is preserved; it requires a normal bladder wall and bladder capacity exceeding 400 ml.

Female↗
PubMed1986

Management of neurogenic urinary incontinence with AMS artificial urinary sphincter.

The AMS artificial urinary sphincter was implanted in 33 patients with neurogenic urinary incontinence during a 10-year period. All sphincter types were employed, from the earliest AS 721 model to the latest AS 800. The mechanically unstable AS 721 and 761 types have all been removed and, when possible, replaced by later models. In 27 of the 33 patients the device is still in situ, and in 6 (18%) it was removed, mainly because of urethral erosion. Increasingly favourable sphincter survival rats have been obtained. The overall survival rate for model AS 742 was 55% (7 years) for first implant, while the 4-year survival rate for AS 791/792 was 90%. Successful control of voiding function, defined as complete continence or slight but not socially inconvenient incontinence, was obtained in 25 patients (76% of the series).

Adolescent↗
PubMed1985

Functional bladder neck obstruction. Results of endoscopic bladder neck incision in 131 consecutive patients.

Endoscopic diathermy incision of the bladder neck was carried out as a routine procedure in 131 consecutive male patients with an established diagnosis of functional bladder neck obstruction. Follow-up after 3 months revealed excellent symptomatic and urodynamic results. Morbidity was low and the post-operative stay in hospital short (median 2 days). Patients must be informed of the risk of retrograde ejaculation associated with the procedure and objective evidence of the diagnosis is essential.

Adult↗
PubMed1985

Economy in transurethral prostatectomy.

The economy in transurethral (TURP) versus transvesical (TVP) prostatectomy was evaluated in a prospective randomized study. Forty-three patients were allocated to TURP and 32 to TVP. All patients had clinically benign, medium-sized prostatic hyperplasia. Median postoperative ward time was 15 1/2 days following TVP, compared with 7 days following TURP. Statistically significant differences between the two groups in favour of TURP were also seen in the duration of anaesthesia for prostatectomy, in the amount of antibiotics and i.v. infusions used, as well as in number of postoperative outpatients visits. No difference was observed in number of patients readmitted to hospital within 6 months due to sequelae of the prostatectomy. Postoperative sick-leave was 4 weeks following TVP, compared with 2 weeks for TURP patients. However, in the present study the patients' own expenses related to the operation were small and revealed minor differences in favour of TURP. It is stressed that increasing application of TURP in medium-sized prostatic hyperplasia may imply a substantial reduction in the waiting lists as well as an estimated retrenchment for the Danish community of US $3400 (34000 D.kr.) per patient or at least $4.5 million (45 million D.kr.) per year.

Aged↗