Gastrectomy for recurrent ulcer after vagotomy: five- to nineteen-year follow-up.

Sixty patients with recurrent ulcers after vagotomy were treated by partial gastrectomy without revagotomy. One patient died after surgery. Seven others died of unrelated causes and one patient was lost to follow-up before 5 years, without rerecurrence having been diagnosed. Of the remaining 51 patients, one underwent reoperation for rerecurrent ulcer and four for postgastrectomy symptoms before 5 years of follow-up. Forty-six others were followed for between 5 and 19 years, in addition to the one postoperative death. Major postoperative complications occurred in four other patients. Recurrent ulceration developed in four of 51 patients. The patients were classified according to a modified Visick system with regard to recurrent ulceration and postgastrectomy symptoms: Visick I, 16 patients; Visick II, 14 patients; Visick III, 11 patients; and Visick IV, 11 patients. Gastrectomy after vagotomy can be achieved with a low mortality and recurrent ulcer rate but with a high incidence of postgastrectomy symptoms.

A novel non-adrenergic, non-cholinergic nerve-mediated relaxation of the pig bladder neck: an examination of possible neurotransmitter candidates.

Electrical field stimulation of the isolated pig bladder neck preparation initiated rapid non-adrenergic, non-cholinergic nerve-mediated relaxations. A wide range of substances were examined as possible candidates for the neurotransmitter involved. Of these, only 5-hydroxytryptamine, vasoactive intestinal polypeptide, adenosine and adenosine 5'-triphosphate produced relaxations. Noradrenaline, acetylcholine, substance P, bradykinin and angiotensin II caused contraction, while neurotensin, somatostatin, bombesin and gamma-amino butyric acid were without effect. The nerve response was not blocked by methysergide, ketanserin, chymotrypsin, apamin or 8-phenyltheophylline, although methysergide antagonised the responses to 5-hydroxytryptamine, chymotrypsin blocked the responses to VIP, and 8-phenyltheophylline antagonised the responses to adenosine and ATP.

Secondary treatment of advanced cancer of the prostate with Zoladex.

Twelve patients with advanced prostatic carcinoma and relapse following previous hormone manipulation therapy were treated with Zoladex-depot every 4 weeks. The treatment was well tolerated and the endocrine response was satisfactory. However, no clinically important improvement was obtained.

Pelvic floor muscle thickness measured by perineal ultrasonography.

Pelvic floor muscle thickness was assessed in nine healthy female physiotherapists by perineal sonography. All measurements were performed as triple-measurements. The aims were to assess the reliability of the measurements and to establish a reference material. The muscle thickness at rest and at contraction was 9.4 +/- 0.8 mm and 11.5 +/- 1.1 mm respectively (mean +/- SD). Contraction increased the thickness by 2.2 +/- 0.8 mm or 23 +/- 8%. The intra- and inter observer standard deviation of the estimate was in the range of 4-6%. In conclusion, we find the reliability of the measurements acceptable.

Biofeedback treatment of bladder dysfunction in multiple sclerosis. A randomized trial.

Fifteen women and five men with bladder dysfunction due to multiple sclerosis were randomized to plus/minus biofeedback using bladder pressure and simultaneous EMG registration via surface electrodes. All the patients had behavioural modification, pharmacological adjustment and pelvis floor training. The number of incontinence episodes decreased and maximal cystometric capacity increased, while first sensation and pad test were unchanged. Subjective treatment results assessed by visual analogue scales for incontinence and obstrusive voiding symptoms were highly significant. However no biofeedback parameter was improved and no difference could be demonstrated between the two treatment groups. In conclusion the used biofeedback technique is insufficient and the 60 min. standardized pad weighing test is inadequate in this type of patients.

Flexible fiberoptic versus conventional cystourethroscopy in bladder tumor patients. A prospective study.

In 30 bladder tumor patients flexible fiberoptic and conventional cystourethroscopy was undertaken by two urologists in a random sequence. The findings at conventional cystoscopy, including histologic findings in biopsy and operative specimens, were taken to represent the true pathologic condition. Concordance was found in all but three patients, with solitary superficial grade II bladder tumors less than 2 mm in diameter that were overlooked at flexible cystoscopy. No discordance was observed in the evaluation of grade III or invasive bladder tumors. Flexible fiberoptic cystourethroscopy with urine cytology is recommended 1) as a follow-up investigation under local anesthesia in patients with non invasive bladder tumors and negative random biopsies, and 2) as a diagnostic procedure in poor-risk patients as an alternative to transabdominal ultrasonography.

Influence of prostaglandins and ketoprofen on contractile responses of human and pig detrusor and trigone muscles in vitro.

Detrusor and trigone smooth muscle from pig and man were investigated in vitro. The strips were adjusted to a tension of 1 g. During the first hour detrusor strips relaxed and had to be lengthened repeatedly to maintain tension. The tension of strips from the trigone increased spontaneously during this initial period of recovery and accommodation. Detrusor contractions evoked by transmural electric field stimulation, carbachol, histamine and Ca++ were reduced by ketoprofen (an inhibitor of prostaglandin synthesis), while contractions evoked in trigone strips were augmented by ketoprofen. PGE2 10 nM reversed the effect of prostaglandin synthesis antagonism, augmenting the reduced detrusor response and reducing the augmented trigone response. PGF2 alpha augmented evoked contractions in strips from all regions. Activation of endogenous prostaglandin production can not explain the strip behavior during recovery. After recovery, synthesis of the E-type of prostaglandins seem to dominate over the F-type of prostaglandins, since annulment of the E-type of prostaglandins explains best the alterations of evoked contractions following prostaglandin synthesis antagonism.

Non-cholinergic, non-adrenergic inhibitory nerve responses of bladder outlet smooth muscle in vitro.

Pig trigone, bladder neck and urethral smooth muscle strips blocked with atropine, phentolamine, propanolol and the prostaglandin synthesis inhibitor ketoprofen were exposed to transmural electric field stimulation in vitro. The strips developed a fast and reproducible relaxation which was sustained during the period of stimulation and ceased slowly after stopping stimulation. The amplitude of the relaxation was proportional to the basal tension. The relaxation was nerve-mediated, since selective nerve blockade with tetrodotoxin abolished the response. Calcium influx inhibition with verapamil did not antagonise the relaxation, while omitting Ca++ from the bath solution caused maximal relaxation. Vasoactive intestinal polypeptide and adenosinetriphosphate evoked submaximal and slowly developing relaxation.

Enkephalin inhibits presynaptically the contractility of urinary tract smooth muscle.

The influence of methionine-enkephalin and leucine-enkephalin on human detrusor and on pig detrusor, trigone, bladder neck and urethral smooth muscle was investigated in vitro. The enkephalins inhibited the smooth muscle contractility presynaptically. Methionine-enkephalin was about 40% more potent than leucine-enkephalin. Phentolamine-resistant contractions were less inhibited by the enkephalins than atropine-resistant contractions and contractions that were not blocked. The inhibitory nerve responses of the trigone, bladder neck and urethra were unaffected.

Non-cholinergic, non-adrenergic nerve-mediated relaxation of pig and human detrusor muscle in vitro.

Previously unrecognised, nerve-mediated relaxation in pig and human detrusor muscle is described. The relaxation was mediated via non-cholinergic, non-adrenergic and non-prostaglandin transmitter or modulator systems and was present in 12 of 15 detrusor strips from six pigs and in four of 15 detrusor strips from seven patients. A contractile phase preceded relaxation in all strips; in contrast to the contractile phase, relaxation was augmented by an increase in basal tension in a complex way and possibly by the slowest stimulation frequencies.

Reproducibility and reliability of urinary incontinence assessment with a 60 min test.

Urinary incontinence was objectively assessed in 50 patients. The urine loss was measured as weight gain of perineal pads worn during a 60 min standardized activity period. The test was initiated by drinking 500 ml (not milk and soda water). The patients were instructed not to void before and during the test. After the test, the voided volume was collected. The test proved handy, reproducible and reliable compared to the subjective day-time incontinence. Prior to the actual test, 15 patients participated in a pilot study having an initial voiding and a test period of 3 1/2 hours. This longer test period was not found practical and the gain in positive diagnosis was minimal compared to the disadvantages with a higher number of unscheduled voidings.

Vasoactive intestinal polypeptide influence on lower urinary tract smooth muscle from human and pig.

The influence of vasoactive intestinal polypeptide on detrusor, trigone, bladder neck and urethral smooth muscle from human and pig was investigated in vitro. Vasoactive intestinal polypeptide reduced the tension and amplitude of the spontaneous contractions of strips from all regions studied. Human detrusor and pig trigone, bladder neck and urethral strips were more sensitive to vasoactive intestinal polypeptide than pig detrusor. The response was reversible, reproducible and dose-dependent from 10(-9) to 10(-6) mol. per liter. The time to onset of the response was within 1/2 minute and the time to maximal relaxation was 2 to 10 minutes. The response was not affected by selective nerve poisoning with tetrodotoxin, beta-adrenergic blockade with propanolol or prostaglandin synthesis blockade with ketoprofen. Vasoactive intestinal polypeptide did not prevent prostaglandin E2 activity on the musculature. Contractions evoked by transmural electric field stimulation or pharmacologically with carbachol, noradrenaline, substance P and prostaglandin F2 alpha were equally reduced by VIP 10(-7) mol. per liter.

Influence of serotonin on lower urinary tract smooth muscle in vitro.

The influence of serotonin (5-hydroxytryptamine) on human detrusor and on pig detrusor, trigone, bladder neck and urethral smooth muscle was explored in a series of in vitro experiments. Serotonin evoked a dose-dependent and reversible contraction of the detrusor. The reverse response was triggered in trigone, bladder neck and urethral smooth muscle--a dose-dependent and reversible relaxation. The maximum amplitude of this relaxation was 85 +/- 15% of the relaxation produced by electrical nerve stimulation. The effect of serotonin was unaltered by blockade of ganglia, alpha- and beta-adrenergic receptors, cholinergic receptors and prostaglandin synthesis. The serotonin antagonists ketanserin, methysergide and cyproheptadine partly inhibited the effect of serotonin. The antagonism differed in potency on strips of different origin. The antagonists were ineffective or minimally effective in blocking responses to nerve stimulation. The effect of serotonin was probably mediated by specific serotonin receptors different from the serotonin-S2-receptors predominating in vascular smooth muscle. Serotonin is a potential neurotransmitter in lower urinary tract smooth muscle, but its importance in micturition physiology and pathophysiology is unknown.

The accuracy of the frequency-volume chart: comparison of self-reported and measured volumes.

OBJECTIVE: To assess the accuracy of frequency-volume charts recorded by patients with voiding symptoms by comparing self-reported voiding data with the volumes of urine collected in same period. PATIENTS AND METHODS: The study comprised 18 patients (median age 63 years, range 20-80) and lasted 3 days, during which the patients recorded their fluid intake and voided volumes, and collected 24 h urine samples. RESULTS: The recorded volumes exceeded or underestimated the collected volume in 49% and 51%, respectively, of the samples, but the agreement between the accumulated daily voiding volumes on the charts and the volumes collected was acceptable. The median difference between volumes recorded on the charts and collected as samples was 100 (0-1450) mL per 24 h or 10 (0-117) mL per voiding (not significant). The median daily variation of creatinine in the urine was 1.1 (0.1-9.4) mmol (not significant), indicating that the 24 h collection periods were respected. CONCLUSION: Recordings on frequency-volume charts are valid and useful in the investigation of patients with voiding symptoms.