摘要:

ObjectiveTo analyse the pharmacological profile and the anatomical localization of the dopamine D, and D, receptors in sections of the pelvic part of the ureter and of the fundus of the urinary bladder.Patients, materials and methodsSamples of the pelvic part of the ureter and of the fundus of the urinary bladder were taken in men (age range 61k4 years) who were undergoing lower urinary tract surgery. Biochemical characterization and autoradiographical techniques were used on frozen sections of the ureter or the urinary bladder. [3H]‐SCH 23390 was used as a ligand of dopamine D, receptors and [3H]‐spiroperido1 as a ligand of dopamine D2 receptors.Results[3H]‐SCH 2 3 390 and [3H]‐spiroperidol were bound by specific sections of the ureter and of the urinary bladder. The pharmacological profile of the binding was consistent with the labelling of D, and D, receptors respectively. Light microscope analysis of the localization of D1 and D2 receptors revealed the accumulation of the two radioligands in the tunica muscularis of the ureter or of the urinary bladder. Conclusion A possible role of the dopaminergic system in the control of urine flow and of some dysfunctions of the lower urinary tract is su

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07629.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo assess the results from ultrasound‐monitored extracorporeal shock wave lithotripsy (ESWL) for ureteric stones, to compare the results with other treatment modalities and to evaluate experiential audit‐evoked gains.Patients and methodsA review of the records of 109 patients with ureteric stones who were treated during 1990 (Group I) and 69 patients treated by ESWL during the first 10 months of 1991 (Group II), was carried out. All patients with a steinstrasse or fragments secondary to ESWL were excluded from the study.ResultsOf the 109 patients in Group I, 63 were treated with ESWL, nine underwent ureteroscopic push‐up of the stone and 11 underwent catheter push‐up prior to ESWL, 28 underwent ureteroscopic extraction/fragmentation, five underwent post‐ESWL ureteros‐copy and 29 underwent open ureterolithotomy (nine after failed ureteroscopy). Ureteroscopy was successful in fragmentation/extraction of 19 of 28 (68%) stones and 95% of patients were stone‐free at 3 months. All patients who underwent ureterolithotomy and 84% who underwent ESWL (and post‐ESWL ancillary procedures) were stone‐free at 3 months. All patients who underwent ureterolithotomy, 51% of those who underwent ureteroscopy and 56% of patients who underwent ESWL needed only one treatment. The mean stone burdens of patients in Groups I and II were comparable but more patients presented with larger stones (100 mm2surface area) in Group II. The stone‐free rates for ESWL monotherapy with ESWL increased from 84% in 1990 to 92% in 1991. A higher proportion of stones were treatedin situin 1991 and a stent was used less frequently in obstructed ureters. Post‐ESWL procedures fell from 8% in 1990 to 6% in 1991 and the proportion of patients who required more than one treatment fell from 44% in 1990 to 14% in 1991.ConclusionsThe choice of treatment for patients with ureteric stones is critical but will vary depending on the individual's circumstances, the availability of equipment, costs and time required to perform the procedure. The results obtained using ESWL for ureteric stones improved considerably over the course of the study as a result of experience and refinement of the technique. Stones located in more difficult systems such as in kidneys with a thin cortex and those located above the ischial spine were no longer subjected to ESWL. Audit of the results obtained following treatment allows identification of problem areas, alerts physicians to alternative methods of treatment and gives an objective quantification of experience, assisting rational decision making with conseq

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07630.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective To study the efficacy of the Dornier MPL 9000 lithotripter with a real time ultrasound transducer in the localization and treatment of upper and prevesical ureteric stones.Patients and methodsTwo‐hundred and eighty‐five patients with pre‐vesical ureteric stones and 247 patients with upper ureteric stones underwent extracorporeal shock wave lithotripsy (ESWL) using ultrasound targeting, under no regional or general anaesthesia.ResultsAt follow‐up after 3 months 9 7% of patients with pre‐vesical stones and 96% with upper ureteric stones were stone free. Ninety‐nine patients were treated more than once. The average number of sessions of ESWL for all patients was 1.19 (1.17 for patients with prevesical stones and 1.22 for those with upper ureteric stones). Ureteric stenting was employed in 6% of cases. The infrequent use of ureteric stenting did not reduce ESWL efficacy, nor increase either the complication or the retreatment rates. In many cases upper urinary tract dilatation was provoked by administering intravenous fluid and a diuretic.ConclusionIn situechoguided ESWL is a simple, safe and effective technique for treating ureteric stones which can be detected o

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07631.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo study parameters which serve as criteria for differentiation of normal and abnormal uroflowmetrograms.Subjects and methodsA total of 105 subjects were investigated, 43 of whom had no symptoms of dysuria, 57 of whom had dysuria demonstrated as an abnormal uroflowmetrogram, subjective symptoms and a small residual urine volume, and five patients who were about to undergo transurethral resection of the prostate. The three parameters used to specify the shapes of the uroflowmetrogram curves were: (i) the ratio of the maximum flow rate (Qmax) and the voiding time (T100)‐ Qmax/T100; (ii) the ratio of the time to peak flow (TQmax) and the voiding time, TQmax/T100; and (iii) the newly introduced voiding efficiency (e), measured by the ratio of the voided volume (VV) and T100× Qmax, 8 = VV/(T100× Qmax), were taken for each patient.ResultsThe criteria for normal uroflowmetrograms were: Qmax/T1000.78, 0.32 TQmax/T1000.54, 0.63 ε

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07632.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo define pressure, volume and infusion speed criteria for the ice‐water test (IWT).Patients and methodsIn this prospective clinical study, cystometry and IWTs were performed in 115 patients.ResultsThe critical response for a positive IWT was found to be a peak detrusor pressure above 30 cm H2O, with or without fluid leakage. Neither the infusion speed nor the infused volume was critical for the outcome of the test provided that the bladder wall was sufficiently cooled.ConclusionThe IWT is a rapid, simple and robust test, whose results are easy to interpret. The test increases the precision of urodynamic diagnosis, especially in patients with an overactive detrusor dysfunction, at a small cos

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07633.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo control the symptoms of interstitial cystitis with chronic self‐administered intravesical heparin and determine whether the drug's continued use can sustain remission.Patients and methodsA total of 48 patients were selected to undergo intravesical heparin therapy, 10000 units in 10 ml sterile water, three times per week for 3 months. For patients who attained a good clinical remission, therapy was available for up to a further 9 months.ResultsAt 3 months 27 of 48 patients (56%) attained good clinical remissions. All were offered continuous therapy and 23 elected for an additional 3 months. Twenty of the 23 continued in remission. Sixteen of these patients elected to have a further 6 months of therapy (12 months total) and 15 of 1ft remained in remission.ConclusionIn over half of the patients studied, intravesical heparin controls the symptoms of interstitial cystitis with continued improvement even after one year of therap

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07634.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo identify lymphocyte sub‐populations within the bladder wall in normal controls, in patients with bacterial cystitis (BC) or interstitial cystitis (IC).Patients and methodsBladder biopsies were taken from 21 patients with IC, four with BC and five normal controls. Immunofluorescent staining of biopsies was performed using monoclonal antibodies to the Tcell markers CD3, CD4, CD8, TCRδ1, δTCS1, βF1 and IML. Plasma cells were identified using monoclonal antibodies to IgA, IgG and IgM. The location and numbers of cells were determined. Peripheral blood lymphocyte counts were also performed in each case.ResultsT cells (CD4+ and CD8 +) were significantly more abundant within the bladder biopsies from patients with interstitial cystitis than in those from the normal controls, and were present within the urothelium and submucosa but not the detrusor. There was no difference between the numbers of T cells present in the biopsies from patients with interstitial cystitis and in those with bacterial cystitis. However, the presence of γδγ T cells was significantly associated with interstitial cystitis. IgA + and IgM + plasma cells were located within the urothelium and submucosa but not the detrusor in patients with IC and the numbers present in these patients were significantly greater than in those with BC or the normal controls. The peripheral blood lymphocyte counts were not altered in any of the study cases.ConclusionThe increased numbers of CD4 +, CD8 + and γδ T cells as well as IgA +, IgG+ and IgM + plasma cells within the urothelium and submucosa in patients with IC suggest that these cells play an active role in the pathogenesis of the disorder. The previously described abnormal urothelial expression of HLA‐DR and hyperexpression of Class I molecules in patients with IC may enable these cells to cause destruction of the urothelium ‐ the en

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07635.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo determine the frequency of mutations of the H‐ras gene in transitional cell carcinomas of the human urinary bladder using direct DNA sequencing based on the polymerase chain reaction (PCR) method and to compare the results with those of other methods. In addition, the relationship of the mutation frequency to tumour stage and grade was examined.Patients and methodsBladder tumour samples, taken by cystoscopic resection from 50 patients with newly diagnosed transitional cell carcinoma of the urinary bladder, were analysed by PCR‐based direct DNA sequencing for point mutations in the H‐ras gene at codon 12.ResultsPoint mutations were found in 9 of 50 tumours examined (18%). The most frequent mutation (8/9) was a G to T transversion converting GGC to GTC, which would result in a glycine to valine substitution. The remaining mutation was a G to A transition altering GGC to GAC, producing a glycine to aspartic acid substitution, which has not previously been reported in bladder cancer. In all tumour samples examined the wild‐type allele (GGC) was also evident. Variation in the proportion of wild‐type to mutated sequence was found within tumour samples. No relationship between mutations and tumour grade and stage was apparent.ConclusionThe frequency of H‐ras mutations detected in this first large scale study using the highly sensitive and rapid PCR‐based sequencing method was comparable to that reported by earlier studies with the nude mouse tumorigenesis variation of the 3T 3 transfection assay. H‐ras mutations can be early events in the development and progression of a significant proportion of human bladd

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07636.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo determine if transitional cell tumours of the bladder which contain mutations in the p53 gene have alterations in their DNA content.Materials and methodsIn 33 transitional cell tumours of the bladder, DNA content was determined by flow cytometry and compared with expression of mutant p53 as assessed by immuno‐histochemistry.ResultsAbnormal DNA content was associated with increased staining for p53 (P<0.05), high tumour stage (P<0.001) and increased histological grade (P<0.01). Although positive staining for p53 was frequently associated with abnormal DNA content, a significant number of non‐diploid tumours stained negatively for mutant p53.ConclusionThese data demonstrate that increased staining for p53 is associated with abnormalities in DNA content suggesting that mutation of the p53 gene is associated with an increased rate of chromosomal abnormalities and an increased rate of cell proliferat

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07637.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo determine whether p53 expression is a marker of tumour progression in superficially invasive (pTl) transitional cell carcinoma of the bladder.Patients and methodsThe immunohistochemical status of the p53 protein in 28 pTl primary bladder cancers was determined on frozen tissue and archival paraffin block sections using three primary antibodies (CM‐1, PAB1801 and D07). The findings were compared with the patients' progress. All the patients, except for those who died during the course of the study, were followed up by check cystoscopy for a minimum of 2 years.ResultsImmediately adjacent frozen sections stained identically in 10 of 16 cases for CM‐1 and PAB1801. For paraffin sections, identical staining patterns were seen for PAB1801 and D07 in 21 of 26 sections. However, inter‐ and intra‐tumour staining for p5 3 was very variable, even with the same antibody. The heterogeneity of p53 positive cell distribution in the tumours indicates potential for significant sampling errors if random sections are chosen as representative of p53 status.ConclusionThe p53 status of the primary tumours did not relate to patient outcome. The results obtained do not support the use of immunohistological p53 expression as a discriminating prognostic indicator in pTl transitional cell carcinoma of the

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07638.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY