ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16056.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—Single kidney glomerular filtration rate (SKGFR), single kidney blood flow (SKBF) and differential renal function (DRF), using both technetium labelled diethylenepenta‐acetic acid (99mTc‐DTPA) and dimercaptosuccinic acid (99mTc‐DMSA), were examined as predictors of outcome in a pig model of complete unilateral ureteric obstruction. SKGFR and SKBF were unable to predict outcome following relief of obstruction but there was a high curvilinear correlation between DRF assessed at the end of defined periods of obstruction and after relief of obstruction using99mTc‐DMSA. Functional recovery was near complete using DMSA when the loss in DRF did not exceed 30%, after which there was an exponential decline in expected recovery.There was no difference between DRF using99mTc‐DTPA or99mTc‐DMSA in controls or before or after obstruction but significant differences between assessment by these radionuclides existed in the obstructed kidney at 24 h, 5 days, 10 days and 20 days.99mTc‐DMSA is a sensitive agent in the prediction of outcome following acute complete obstruction in the pig but its assessment of DRF in the obstructed kidney differs markedly from th

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16057.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—The aim of this study was to identify the changes in secretion of prostaglandins into the urinary tract as a result of treatment by extracorporeal shock wave lithotripsy (ESWL) and to determine their effects on ureteric motility.Sixteen patients with renal or upper ureteric calculi were studied. A peripheral blood and urine sample was collected immediately before and after ESWL, with further samples taken 24 h later. The following variables were assessed by radioimmunoassay: prostaglandin E2(PGE2), prostaglandin F1α (PGF1α), and thromboxane B2(TXB2). Anin vitrocanine study was then designed to study the activity of TXB2, PGF1α and PGE2on an isolated intact canine ureter model.Significant elevations of TXB2were found immediately after ESWL in both serum and urine, which fell almost to pre‐treatment levels by 24 h. PGF1α levels showed significant elevations at 24 h but no immediate increase as seen with TXB2. In contrast, PGE2levels were unchanged in the urine but significantly decreased in the serum.In vitrostudies showed that both TXB2and PGF1α repeatedly produced an increased frequency of ureteric contraction.ESWL results in the release of prostaglandins from the urinary tract which are shown to cause increased ureteric per

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16058.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—Clinicians have no yardstick to help them choose the most efficient lithotriptor. Their leading priority is a system allowing complete disintegration of the stone with the minimum number of shocks and a low re‐treatment rate. One of the prerequisites of this system is a powerful shock wave generator. “Power” is as yet ill defined in lithotripsy. Therefore clinicians' choice depends upon other factors.Acoustic output measurements were recorded on 3 commercial lithotriptors representing the 3 main shock wave generating systems. These were the Dornier MPL 9000 (standard and X‐155 electrodes), the Siemens (Lithostar, Lithostar Plus and System C) and the Wolf Piezolith 2300. The shock wave measurements were correlated to the capability of the lithotriptors to disintegrate standard stone modelsin vitro.Two factors were identified. The pulse intensity integral in the focus and the size of the focal zone proved to be the most important factors to assess and compare the efficacy or “power” of different lithotriptors. Together they can help clinicians to identify and choose the most efficient shock wave gener

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16059.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—Colour flow Doppler ultrasonography (US) was used in 24 renal masses (12 benign, 12 malignant) to investigate the vascularity of the lesion and thus to characterise the mass. A colour flow Doppler US device (Toshiba 270 A) with a convex probe of 3.75 MHz was used. Colour flow and the peak‐systolic Doppler shift frequency obtained from the renal mass were used to distinguish between benign and malignant lesions. Ten of 12 malignant lesions demonstrated colour flow together with Doppler signals greater than 2.5 kHz (mean 3.5 kHz). None of the 12 benign renal masses demonstrated colour flow or tumour signals. The majority of malignant lesions give rise to neovascularisation and so high frequency Doppler‐shifted signals. Thus colour flow Doppler sonography is the most reliable means of differentiating benign from malignant renal m

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16060.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—A review was made of 127 percutaneous nephrostomies (PCN) in 106 patients with benign (74 patients) and malignant (32 patients) urinary tract obstruction. Data on underlying aetiology, complications, subsequent management and long‐term management are presented. The study confirms that PCN is an effective and safe method of providing temporary or prolonged urinary diversion in obstruction. Its use in pelvic malignancy should be determined by the likelihood of obtaining worthwhile prolonged palliation in individual patie

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16061.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—There is general acceptance that the best substitute for a damaged distal ureter is an elongated bladder and that the bladder psoas hitch is the most reliable procedure. Nevertheless, it is not always sufficient to bridge a long ureteric gap.In order to obtain an equally safe but wider bladder elongation than the psoas hitch can provide, we have previously studied the effect of several Z‐shaped incisions on isolated pig bladders. The aim of the present study was to verify,in vivo, the efficacy and safety of the new technique. Five sheep underwent the psoas hitch procedure and 6 the Z‐plasty procedure. The results showed that Z‐plasty provides an equally safe but longer bladder elongation than the psoas hitch pr

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16062.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—This study reviews 6 patients who were referred with severe loin pain radiating to the groin and in whom a presumptive diagnosis of ureteric colic was made. Of these, 3 patients were found to have carcinoma of the pancreas and the remaining 3 had retroperitoneal lymph node metastases. Retroperitoneal malignancies rarely present with loin pain, but this diagnosis should be considered in patients with long‐standing loin pain in whom an obvious diagnosis is not appar

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16063.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—The ice‐water test is a simple supplementary urodynamic test that increases the precision of the diagnosis of overactive bladder subtypes. A similar bladder cooling reflex has recently been characterised in the cat and was found to originate from specific cold receptors in the bladder wall. In the present study, the threshold temperature of the human bladder cooling reflex was determined in patients with positive ice‐water tests. Estimated threshold values were somewhat lower than those of the cat but still well above the temperatures required for cold stimulation of nociceptors. As in the cat, the strength of the cooling reflex varied inversely with the bladder temperature. These findings indicate that the human bladder cooling reflex is in principle organised in the same way as that of laboratory animals. The human bladder thus seems to be endowed with cold receptors with excitatory reflex connections to the det

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16064.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—The results of cystometrograms and ice‐water tests (IWTs) were retrospectively evaluated in 557 patients with overactive bladders, lower motor neuron lesions or pure stress incontinence. The IWT was considered positive when, following ice‐water instillation, the fluid was expelled from the bladder within 1 min. The test was considered false negative when no fluid escaped despite a sustained detrusor contraction of the same magnitude as the micturition contraction. Ninety‐seven percent of patients with complete and 91% of those with incomplete upper motor neuron lesions had a positive or a false negative IWT. About 75% of the patients with multiple sclerosis, Parkinson's disease or previous cerebrovascular accident had a positive IWT. All patients with lower motor neuron lesions or pure stress incontinence had a negative IWT. There was a significant correlation between a positive IWT and an abnormal sensation of bladder filling and inability to inhibit micturition voluntarily, as well as between a negative IWT and the occurrence of phasic detrusor contractions during cystometry. The study shows that the IWT is a sensitive test for differentiating upper from lower motor neuron lesions. It is also a useful parameter for functional subdivision of overactive bladders. In patients with voiding dysfunction in the absence of lower urinary tract inflammation, a positive test is an indicator of a silent or overt neurological d

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16065.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY