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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↗

Chemical fractionation of metals in wetland sediments: Indiana Dunes National Lakeshore.

Tessier-type (1979) sequential extractions for heavy metals (Cd, Cr, Cu, Fe, Mn, Pb, and Zn) were conducted on sediments from two wetland sites, one inundated and the other drained, within the Indiana Dunes National Lakeshore (IDNL), NW Indiana, with the objective of (i) evaluating extraction techniques on organic-rich sediments, (ii) determining the geochemistry and mobility of potentially biotoxic trace metals in a contaminated environment, and (iii) considering the implications of different restoration strategies on the potential for heavy metal remobilization. Long and repeated extractions were needed to effectively degrade the organic-rich sediments (up to 75% of the sediment by mass). Analysis of sulfur fractionation revealed that it was predominantly sequestered along with the organically bound fraction (renamed oxidizable). Metal recovery was good with the sum of the extractant steps typically within 20% of the total metal concentration determined after total microwave digestion. Results showed metal fractionation to be both metal- and site-specific, The oxidizable fraction is dominant for Cu, Cr, and Fe (>65% of the nonresidual fraction for almost all samples) and overall is most important also for Cd and Pb. The iron/manganese oxide fraction is important for Pb, Mn, and Zn, particularly at the drained site. The carbonate bound fraction is relatively insignificant at both sites, except for Cd and Mn, although it is more important at the drained site. The exchangeable fraction is significant in the uppermost sediments at the drained site, particularly for Cd (3-24%), Pb (3-14%), and Zn (36-45%); whereas, for the inundated site, it ranged only from 0 to 1% Zn, with no detectable Cd or Pb. Chromium, Cu, and Fe exist in forms not likely to be remobilized, whereas Cd, Mn, Pb, and Zn are potentially mobile if drained wetland sites are reflooded (and pH and redox potential altered). Simple mass balance calculations illustrate the potential for the removal of approximately 84,375 kg of exchangeable Zn if currently drained sites across the IDNL are reflooded, with concentrations in water draining into Lake Michigan as high as 5 ppm.

Ecosystem↗

Pulsed-field electrophoretic fingerprinting of Salmonella indiana and its epidemiological applicability.

Eight Xba I-generated pulsed-field profile (PFP) types and four subtypes within one of the most common PFP types have been identified in Salmonella indiana from patients, poultry and human food in England and Wales in the three-year period from January 1994 to December 1996. Two PFP types have predominated, PFP X1 and PFP X2. Although the PFP X1 type was identified throughout the study period, the PFP X2 type was not identified until late 1995, subsequently becoming the most common PFP type in humans in the first six months of 1996 with a significant distribution in elderly patients. It is concluded that PFGE can be used in support of epidemiological investigations for the subdivision of Salm. indiana. Furthermore, as both conditions and interpretation criteria can be easily standardized, it is suggested that for many salmonella serotypes, PFGE can provide the basis for a definitive scheme of genotypic subtyping suitable for epidemiological investigations at both a national and international level.

Aged↗

Holmium:YAG laser endoureterotomy in the treatment of ureteroenteric stricture following Indiana urinary diversion.

A 57-year-old man who had received radical urethrocystectomy and Indiana urinary diversion 6 months earlier was treated for ureteroenteric anastomosis stricture (left side) using a Holmium:YAG laser via antegrade approach. The availability of small (6.9 Fr) flexible ureteroscope, as well as the use of the Holmium:YAG laser has facilitated the ability to precisely incise the stricture under direct endoscopic visualization. The technique is described for laser endoureterotomy in a patient with ureteroenteric stricture following Indiana urinary diversion.

Anastomosis, Surgical↗

Beta PP participates in PrP-amyloid plaques of Gerstmann-Sträussler-Scheinker disease, Indiana kindred.

Gerstmann-Sträussler-Scheinker disease in the Indiana kindred is pathologically characterized by deposits of PrP-amyloid, neurofibrillary tangles and degenerating neurites. The aim of this study was to investigate seven patients of different ages for beta PP and A beta immunoreactivities associated with PrP-amyloid deposits and degenerating neurites. In one asymptomatic individual with PrP-amyloid deposits, Alz50 and A beta immunoreactivities were absent. In six symptomatic patients, the degenerating neurites surrounding PrP-amyloid deposits were labeled by Alz50 and by antibodies to synaptophysin, ubiquitin and the N- and C-terminal domains of beta PP. In one symptomatic, senile patient, A beta immunoreactivity was present in the extracellular space, often in association with PrP-amyloid deposits. The analysis of the immunohistochemical findings suggested that in the Indiana kindred the intracellular accumulation of beta PP, synaptophysin and ubiquitinated material most probably revealed a reaction of neurites to PrP-amyloid, whereas the extracellular deposition of A beta was likely an age-related phenomenon.

Aged↗

Comparison of urine cytology between the ileal conduit and Indiana pouch.

OBJECTIVE: To compare the cytomorphologic features of urine obtained from two different kinds of urinary diversions constructed after total bladder resection. STUDY DESIGN: The smears of urine from 11 ileal conduits and 6 Indiana pouches were evaluated. All patients underwent total bladder resection due to transitional cell carcinoma (TCC) or other kinds of cancer before urine diversion. RESULTS: The cytologic features of Indiana pouch urine include degenerated, small, round cells without columnar cells derived from intestinal epithelium. In ileal conduit urine, well-preserved columnar cells and degenerated, small, round cells were frequently observed. The columnar cells in ileal conduit urine exhibited cytologic features that should be distinguished from TCC cells. CONCLUSION: The method of reconstructing the urinary tract is important in urine cytology from urine diversions because the cytomorphologic features of urine are different between the two kinds of urinary diversions. Since columnar cells in ileal conduit urine might lead to misdiagnosis as TCC, special consideration is required to examine ileal conduit urine.

History, 16th Century↗

Evaluation of nested polymerase chain reaction, pepsin/trypsin digest, and histology for the detection of Myxobolus cerebralis in salmonid fishes of Indiana and Michigan.

The objectives of this study were to survey fish from state hatcheries in Indiana and Michigan and to compare the nested polymerase chain reaction (PCR) test with pepsin/trypsin digest (PTD) and histopathology for the diagnosis of whirling disease (WD). One group of 40 and 9 groups of 60 fish heads, for a total of 580 samples, were submitted from hatcheries in Indiana and Michigan. These samples were examined for myxozoan spores using histopathology, PTD, and PCR tests. The heads were hemisectioned, and one half was fixed in 10% neutral-buffered formalin for histopathologic examination. The other half was processed for PTD. Some of the sediment was examined for the presence of myxozoan spores, and the rest was prepared for the nested PCR. Histologic examinations did not reveal Myxobolus cerebralis in any of the 580 samples. One hundred serial step sections, taken at 5-microm intervals, were evaluated for samples with positive spore identification by PTD. Histologic examination of these sections failed to reveal any myxozoan parasites. Myxozoan spores were observed in 16.9% (98/580) of samples in sediment after PTD. Spores morphologically similar to those of M. cerebralis were observed in 1.0% of PTD samples (n = 6). The nested PCR indicated that M. cerebralis spores were present in 0.5% of samples (n = 3). All 3 nested PCR-positive samples came from the same hatchery, however, spores of M. cerebralis were seen in 1 sample, spores of other myxozoan species were seen in the second sample, and spores were not seen in the third sample. When comparing the PTD to the nested PCR test, the PTD diagnosed 1 true positive, 5 false positives, 2 false negatives, and 572 true negatives, for a sensitivity of 33% and a specificity of 99.1%. Screening for M. cerebrallis infection in this study indicated a low prevalence of the disease. Histopathology was a very insensitive indicator of WD. The PCR test was highly specific and was used to differentiate spores of M. cerebralis from similar spores of other species.

Animals↗

Susceptibility of mansonia indiana (Diptera: Culicidae) to nocturnally subperiodic Brugia malayi (Spirurida: Filariodea).

Mosquitoes, Mansonia indiana Edwards, 1930, were collected from non-endemic area of human lymphatic filariasis and tested for their susceptibility of infection using nocturnally subperiodic Brugia malayai Buckley & Edeson, 1956. Three cats naturally infected with B. malayi were used in the experiment for mosquitoes feeding. The data revealed that the susceptibility of mosquito infection ranged from 30 to 70%. The results also revealed that the susceptibility rates were not linearly correlated to the microfilarial densities in the cat at the time of feeding. The microfilarial density in cats ranged from 15 to 27 per 10 microl of blood whereas the mean number of third stage larvae in the infective mosqiitoes ranged from 21.6 to 26.8. In addition, statistical analysis showed no significant difference (P > 0.05) between the mean number of third-stage larvae in mosquitoes and the density of microfilaria in cats. The study indicated that Ma. indiana, collected from non-endemic areas, is capable for transmitting the nocturnally subperiodic B. malayi.

Animals↗

Test-retest reliability of the Reitan-Indiana Neuropsychological Test Battery for Children Aged 5 Through 8.

The present study attempted to assess the test-retest reliability of the Reitan-Indiana Neuropsychological Test Battery for Children aged 5 through 8 and to establish the magnitude of practice effects for a normal sample of school aged children. The sample population included 191 kindergarten and 193 second grade students who were administered the entire Reitan-Indiana Battery during the first year of the study and again at one year follow-up. Correlation analyses of random half samples of the population revealed 35 of the 39 test indices measured were stable for at least one of the half samples for the younger (kindergarten-first grade) sample with the same being true for 31 of the 39 variables assessed for the older (second-third grade) sample.

Child↗

Long-term follow-up of the Indiana pouch: efficacy of the pouch construction using the absorbable gastrointestinal staples.

The Indiana pouch procedure was used on 34 bladder cancer patients. The Heinecke-Mikulicz reconfiguration was carried out, involving the conventional hand-sewn and the absorbable GIA stapled methods with the continence mechanism of a staple-tapered efferent limb. The tunnelled tenial anti-refluxing implantation of ureters was performed. The stapled pouch construction saved approximately 1 h of operating time and reduced by 18% the overall loss of blood. There were 3 complications (wound infection/dehiscence in two, leakage from the enteric anastomosis in one, and acute renal failure in one) within 30 days postoperatively. As a late complication, ureter implantation stricture was experienced in two and pouch stone formation in five. No significant difference in the incidence of stone formation was evident between the hand-sewn and the stapled pouches, nor was any difference of pouch volume and catheterization interval. All patients had acceptable continence. These data demonstrated that the Indiana pouch is a reliable procedure with an acceptable complication rate. The pouch construction using the stapled method, which simplified the procedure, is more convenient than the one using the hand-sewn technique.

Absorption↗

Electroconvulsive Therapy: Attitudes and Experience-A Survey of Indiana Psychiatrists.

The American Psychiatric Association survey concerning electroconvulsive therapy (ECT) was repeated with Indiana psychiatrists. The results indicated that these psychiatrists currently were more accepting of ECT than the earlier, national sample. However, there was agreement between the responses of the two groups on many of the issues. There were important differences between those who used ECT and those who did not. In Indiana, responders administering ECT were significantly more likely to be board certified than those who did not employ the technique. As expected, the users were, in general, more enthusiastic and favorable in their attitude toward ECT. The present survey suggests that there may be a greater awareness of adverse side effects and that improvements suggested in the literature are being adopted by practitioners.

Journal Article↗

Investigation of an outbreak of velogenic viscerotropic Newcastle disease in pet birds in Michigan, Indiana, Illinois, and Texas.

An outbreak of velogenic viscerotropic Newcastle disease in exotic pet birds in the United States from April through July 1991 was investigated. More than 2,000 pet birds in 5 states (Michigan, Indiana, Illinois, Texas, and Maryland) were tested. Infected birds were found in Michigan, Illinois, Indiana, and Texas. This disease was eradicated without spread to domestic poultry. Epidemiologic investigations revealed the source of infection to be double yellow-headed Amazon parrots suspected to be illegally imported into Texas.

Animals↗

[Successful trans-stomal operation for multiple urinary stones occurring in the Indiana continent urinary diversion: a case report].

A total cystectomy with the Indiana continent diversion was performed on a 73-year-old man under the diagnosis of invasive bladder cancer in 1992. In 1994 there appeared a few urinary stones in his Indiana continent urinary diversion. Extracorporeal shock wave lithotripsy (ESWL) was successfully performed. In 1999 a few urinary stones recurred and ESWL was performed. Stones could not be discharged because of stricture of the efferent limb, although stones were crushed down into small pieces by repeated ESWL. The number and sizes of stones gradually increased. Dilatation of the stoma followed by a trans-stomal operation was performed and all of the stones except for one were extracted.

Aged↗

[Indiana continent urinary reservoir: technical modifications and late complications].

From October, 1987 through September, 1991, 39 patients underwent construction of Indiana pouch for cutaneous urinary diversion. There were 35 men and 4 women, and their ages ranged from 38 to 77 years (a mean age of 62 years). After the first 8 cases, Indiana pouch was constructed with several modifications which included complete detubularization of the cecum, construction of the pouch augmented with U-shaped ileal patch, and the use of stapled plication. There was no major early complication related to the pouch but one postoperative death of blood transfusion related graft versus host disease. End results were evaluated in 37 patients who were followed for 3 to 49 months. Late complications related to urinary reservoir occurred in 8 patients. The early two patients experienced pouch deformity due to incomplete detubularization of the colonic segment. Two patients had difficult catheterization due to a dilatation of the plicated ileum. One patient had metabolic acidosis requiring hospitalization. Patients perform self-catheterization 4-5 times during the day and 0-2 times at night for volumes ranging from 300 to 1,000 cc. Of 37 patients 34 achieved acceptable urinary continence and one had significant leakage requiring cutaneous bag. The remaining two patients suffered mild nocturnal incontinence. Follow up examination with excretory urography showed no upper urinary tract obstruction except one with unilateral hydronephrosis due to ureteroanastomotic stricture. Reservoirgraphy showed no reflux into the upper urinary tract in all the follow up cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

The modified Indiana pouch.

The modified continent Indiana pouch is based upon the terminal 8-12 cm of ileum and 26-28 cm of right colon. Our modifications include complete detubularization of the colonic segment with an easier appendectomy, a transcolonic ureteral reimplantation that is technically simple, and reinforced plication of the ileocecal junction. This procedure was performed in 70 patients (ages 27-85 years) with follow-up ranging between 3-24 months. There have been five hospitalizations for urinary tract infections or gastrointestinal complications. Three open surgical revisions (4%) have been necessary: one for incontinence, one for a redundant ileal limb and difficult catheterization and one for ureteral stenosis in the mid-portion of the left ureter. One revision is pending for inadequate reservoir volume. Two endoscopic meatotomies of ureterocolonic junction strictures have been necessary. All patients are continent day and night, enjoy easy catheterization of volumes ranging between 400 and 800 cc. The modified Indiana pouch should be considered for any patient requiring cutaneous urinary diversion because of a low complication and revision rate and an excellent continence rate.

Adult↗

Biting rhythm of the vectors of Malayan filariasis, Mansonia annulifera, M. uniformis & M. indiana in Shertallai (Kerala state), India.

Biting activity of Mansonioides mosquitoes through all night collections for a period of two years in Shertallai region, in south India was studied. M. annulifera bites uniformly throughout the night, with two peaks of activity, one after midnight (24.00-01.00 h) and another before dawn (04.00-05.00 h). M. uniformis was found to be predominantly dusk biting, with its peak of activity between 1800 to 1900 h. M. indiana showed two peaks of biting activity one after dusk (2000-2100 h) and another before dawn (0300-0400 h). All biting, with its peak of activity between 1800 to 1900 h. M. indiana showed two peaks of biting activity one after dusk (2000-2100 h) and another before dawn (0300-0400 h). All these species following a particular pattern of activity cycles discerned the biting rhythm of Mansonioides mosquitoes to be species-specific.

Animals↗

Laboratory colonization of Mansonia uniformis, Ma. indiana and Ma. bonneae in Malaysia.

Methods are described for the laboratory colonization of Mansonia uniformis, Ma. indiana and Ma. bonneae in Malaysia. Gravid females oviposited in 500 ml beakers with a layer of water covered with small leaves of Salvinia. Newly hatched larvae were set up in a basal medium of guinea pig dung and water or liver powder, yeast powder and water. Larvae attached to aquatic plants or 'Keaykolour' ruffia snow white paper. The cultures with paper gave better yields than those with plants. Production of Ma. uniformis was higher than the other two species. Twelve generations of Ma. uniformis and 11 generations of Ma. indiana and Ma. bonneae were monitored in the laboratory.

Animals↗

A simplified version of the "Indiana pouch" technique for urinary diversion. Experience of the first 18 cases.

During the last 3 years, a modified technique of the continent urinary diversion, known as the "Indiana pouch" has been performed in 18 patients as part of pelvic exenteration. The narrowing of the ileum and/or the site of Bauchin valve was excluded from the procedure. In order to achieve anti reflux effect, ureters were implanted to the urinary reservoir by the "split cuff nipple" technique instead of tunnelling ureters. Sufficient urine continence and lack of urine reflux in the ureters indicated that satisfactory function could be achieved by the simplified technique. A quality of life questionnaire has suggested that most of our modified Indiana Pouch patients coped well. Operative technique, indications, operative results, and complications are discussed.

Adult↗