Association between Hyposensitivity of C-fiber Afferents at The Proximal Urethra and Storage/voiding Dysfunction in Female Patients with Detrusor Overactivity.

PURPOSE: We examined the associations between urethral sensation and storage/voiding function in female patients with detrusor overactivity (DO) by measuring urethral current perception threshold (CPT). MATERIALS AND METHODS: We retrospectively investigated the medical records of 27 consecutive patients with lower urinary tract symptoms who underwent cystometry, uroflowmetry (UFM), and urethral CPT tests from 2000 to 2015. Patients were classified into 2 groups: with/without DO. Seven DO-negative cases were selected as normal controls on cystometrogram (CMG) matching the inclusion criteria: bladder compliance ?12.5 mL/cmH2O, volume <275 mL at first sensation, and no comorbidities possibly influencing micturition. Finally, 17 patients were included. Urethral CPT was evaluated with intraurethral square-wave impulses at 3 Hz to stimulate C-fibers. Urethral loss coefficient (LC), reflecting urethral resistance during voiding, was calculated by curve-fitting a mathematical model to a UFM waveform. RESULTS: Urge incontinence (UI) was observed in 7 DO-positive patients, but not in those with normal CMG. Urethral CPT and LC were significantly higher in patients with DO than in those with normal CMG. Median urethral CPT significantly increased in patients with both DO and UI than in those without these symptoms (p<0.005). CPT values were correlated with the volume at first sensation (?=0.53, p<0.05) and LC (?=0.59, p<0.05). LC was not calculated in 3 cases due to poor curve-fitting. CONCLUSIONS: In females, urethral C-fiber afferents may become hyposensitive as the detrusor becomes overactive with UI in the storage phase. During voiding, C-fiber hyposensitivity may relate to increased functional resistance of the urethra to urine outflow.

Study on the relation of the shape of the uroflowmetrogram and the urethral loss coefficient calculated from the uroflowmetrogram.

The shape of the uroflowmetrogram reflects voiding conditions. Using a voiding simulation, we examined whether the urethral loss coefficient (LC) calculated from the approximated uroflowmetrogram correlates with parameters that regulate the shape of the uroflowmetrogram. A total of 161 normal and abnormal uroflowmetrograms were used. Normal female subjects and patients before and after transurethral resection of the prostate (TURP) were also studied. The ratio of maximum flow rate (Q(max)) to flow time (T), a parameter expressing the shape of the uroflowmetrogram, was calculated. The uroflowmetrograms were approximated using a voiding model, and the urethral LC was calculated. As a result, a strong negative correlation was observed between the Q(max)-flow time ratio, Q(max)/ T, and LC. Q(max)/T is the vertical to horizontal ratio of the uroflowmetrogram and indicates the average degree of acceleration of flow rate during voiding. On the other hand, urethral LC, which can be estimated from the shape of the uroflowmetrogram, is considered a kind of urethral resistance. We concluded that when urethral resistance is high, the degree of acceleration of flow rate is low on average. Our study also indicated that Qmax/T was less affected by voided volume (VV) compared to Q(max). As Q(max)/T is not as dependent on VV, it is useful for comparing cases with different VV.

Acute subdural hematoma after intra-arterial thrombolysis for acute ischemic stroke--case report.

A 79-year-old man with a cardiac pacemaker for bradycardia fell down and presented with sudden onset of right hemiplegia and aphasia. Initial computed tomography (CT) showed no cerebral infarction but angiography revealed occlusion of the left middle cerebral artery (MCA). Local intra-arterial thrombolysis with tissue plasminogen activator (tPA; tisokinase, 1,600,000 units) was performed 3 hours after the onset, and the MCA was partially recanalized. Further administration of tPA was suspended because of nosebleed. However, the patient's neurological findings did not improve. His consciousness gradually deteriorated to coma and quadriplegia with dilation of the left pupil 2.5 hours after thrombolysis. CT disclosed marked mass effect with a left acute subdural hematoma and a small intracerebral hematoma in the left frontal lobe. He underwent urgent craniotomy and removal of the subdural hematoma. The subdural hematoma originated in a frontal cerebral contusion. He died of severe brain edema 2 days after surgery. Acute subdural hematoma is a very rare complication of intra-arterial thrombolysis. Presumably he had suffered head trauma at the first onset. Evidence of head trauma should be considered a contraindication for the use of thrombolytic agents in a patient with acute stroke.

[A surgical case of subdural hematoma with hemophilia A].

A 54-year-old man presented with unconsciousness. Computed tomography revealed acute subdural hematoma. Emergency evacuation of hematoma was performed showing any excessive tendency to bleed or difficulty to stop bleeding during the operation. However transfusion of fresh frozen plasma was needed to stop continuous bleeding from the surgical wound after the operation. The patient underwent craniotomy again 18 days after the operation because he suffered hemorrhagic infarction and recurrence of acute subdural hematoma. After the second operation, a coagulability examination revealed that his activated partial thromboplastin test was prolonged (74.5 seconds) and his plasma factor VIII level was 20% of normal, so he was diagnosed as having mild hemophilia A. Cranioplasty was accomplished with replacement therapy, and he was discharged with mild recent memory disturbance and homonymous hemianopsia.

Non-invasive estimation of intraurethral pressure profile from uroflowmetric curve.

BACKGROUND: An intraurethral pressure-time profile as urodynamic information was obtained in a non-invasive manner using an equivalent equation as a voiding model. METHODS: The reasonability of the voiding model was confirmed by applying it to an experimental flow curve likened to urinary flow. The flow curve was approximated and the pressure profile was estimated. From the uroflowmetric curves obtained in a normal subject and a patient with bladder outlet obstruction, the respective intraurethral pressure profiles were estimated. RESULTS: The pressure profile estimated from the approximated flow curve was found consistent with the profile of the difference between the pressure actually measured at two different portions in the experimental system. CONCLUSION: Non-invasive estimation of intraurethral pressure profile from uroflowmetric curves may be very useful to grasp intraurethral urodynamic information in clinical practice.

[A case of duret hemorrhage demonstrated by computed tomography].

Brainstem hemorrhage in descending transtentorial herniation is well known as Duret hemorrhage. However, CT or MRI rarely reveals Duret hemorrhage. The authors report a case of brainstem hemorrhage after craniotomy of spontaneous acute subdural hematoma. A 47-year-old man suffered sudden onset of severe headache and progressive consciousness disturbance. Initial CT scan demonstrated a right acute subdural hematoma and a marked shift of the midline structures to the left. Emergency craniotomy was performed but he remained comatose. CT scan after 8 days showed multiple petechial hemorrhages in the brainstem. We reported a rare case of Duret hemorrhage diagnosed by CT scan. Duret hemorrhage is almost fatal.

Diencephalic syndrome of emaciation in an adult associated with a third ventricle intrinsic craniopharyngioma: case report.

OBJECTIVE AND IMPORTANCE: Diencephalic syndrome of emaciation (DS) is seen almost exclusively in infants and young children, and only two cases of DS in adults have been reported previously. We describe a case of DS associated with a third ventricle intrinsic craniopharyngioma in an adult patient. CLINICAL PRESENTATION: A 54-year-old man presented with profound emaciation, disorientation, memory loss, and psychological disorders. Computed tomographic scanning and magnetic resonance imaging of his brain disclosed a tumor within the third ventricle. The preoperative endocrinological examination indicated an elevated growth hormone level and a decreased somatomedin C level. INTERVENTION: The patient underwent partial resection of the tumor, which was adherent to the floor of the third ventricle but not to the ventricle wall, by an interhemispheric-transcallosal approach. The histological examination revealed a squamous papillary-type craniopharyngioma. The patient received 50 Gy of radiotherapy, which resulted in 90 to 95% reduction of the tumor size within 6 months, as indicated by the magnetic resonance images presented. The psychological disorders, memory disturbance, and severe emaciation improved gradually thereafter. CONCLUSION: Although extremely rare, DS can occur in an adult harboring a tumor in the anterior hypothalamus.