bluuebunny/crossref_metadata_2025 huggingface dataset:
Peripheral nerve allografts: Survey of present state in an experimental model of the rat
Authors: Berger Alfred , Lassner Franz
Published: March 2007

Rejection and regeneration processes in peripheral nerve allografts are analyzed in this review of a series of experiments with special reference to the possible clinical application of peripheral nerve allografting in clinical reconstructive surgery. A long segment of the sciatic nerve (2.5 cm) was grafted between congenic rat strains across a maximal genetic barrier; immunohistologically, donor‐ and recipient‐derived structures can be differentiated. If allografting was performed without immunosuppression, a rejection response with consecutive regeneration of minor quality was observed. Under immunosuppression with cyclosporin A no rejection response was observed and regeneration quality was comparable to control autografts. The persistence of donorderived Schwann cells in the immunosuppressed allografts can be demonstrated immunohistologically. After discontinuation of immunosuppression a rejection response is exerted. We conclude that Schwann cells are eliminated from peripheral nerves during rejection. Consecutive regeneration of minor quality is possible, which implies the ingrowth of recipient‐derived Schwann cells into the rejected allograft. Under immunosuppression, allogenic Schwann cells survive and actively promote regeneration. They are still immunologically competent and can exert rejection when immunosuppression is discontinued. A certain degree of replacement of donorderived Schwann cells seems possible. © 1994 Wiley‐Liss, Inc.
Endothelialization of anastomoses in the aorta and inferior vena cava of the rat
Authors: Sigurbjörnsson Björn Th. , Hallberg Eric , Andrén‐Sandberg Åke , Ribbe Else
Published: March 2007

Denuding endothelial damage at anastomoses may lead to thrombotic complications and failure of microvascular reconstructions. Confluent endothelial healing at anastomoses may reduce thrombotic and other complications. The progress of endothelial coverage of anastomotic structures in the aorta and inferior vena cava (IVC) of the rat was evaluated at 3,5,8,11, and 14 days after completion of the anastomoses, by means of scanning electron microscopy. Arterial anastomotic patency was 100%; venous patency was 84%. It was found that endothelial healing progressed towards thin confluent coverage first, thereafter thickening. Coverage was first achieved at the needle defect, then the anastomotic junction, and lastly the suture. The same stage of endothelial coverage of anastomotic structures was reached 5 to 8 days sooner at the IVC anastomosis than in the aorta. © 1994 Wiley‐Liss, Inc.
Early development of suture holding capacity in vascular anastomoses in the rat
Authors: Sigurbjörnsson Björn Th. , Löwenhielm Peter , Agnarsson Bjarni A. , Stenram Unne , Ribbe Else
Published: March 2007

Early development of suture holding capacity (SHC) of end‐to‐end anastomoses in the infrarenal aorta and inferior vena cava (IVC) of the rat was studied by measuring the resistance to tensile forces at 0, 3, 5, 8, 11, or 14 days postoper‐atively. Comparable anastomoses were histologically evaluated. The SHC of the aortic wall decreased following anastomoses and did not regain the strength of nonanastomosed vessels during the first two weeks. The SHC of the IVC also decreased following anastomoses, but regained the strength of nonanastomosed vessels by the 5th day. The relative ultimate strain of the arterial and venous perianastomotic walls decreased slightly, while the relative compliance increased in the aorta and decreased in the IVC. Perianastomotic media necrosis was found exclusively in the arteries. The reduced perianastomotic SHC in the aorta indicates impaired healing, compared to the IVC. Changes in biomechanical properties of the aortic wall following anastomosis may increase its susceptibility to anastomotic complications such as pseudoaneurysms. © 1994 Wiley‐Liss, Inc.
Vascularized bone allografts: Review of current concepts
Authors: Doi Kazuteru , Akino Tatsuhiko , Shigetomi Mitsunori , Muramatsu Keiichi , Kawai Shinya
Published: March 2007

Advances in the field of microsurgery over the past two decades, together with the discovery of a powerful immunosuppressive, cyclosporin A, have brought vascularized osteochondral allografts closer to reality. In this review, the authors describe the history of laboratory research on vascularized osteochondral allografts using immunosuppression, as well as their experimental and preliminary clinical experiences.
Pectoralis major muscle free flap in rat model
Authors: Zhang Feng , Kao Samuel D. , Walker Richard , Lineaweaver William C.
Published: March 2007

The rat pectoralis muscle can serve as a vascularized, innervated muscle flap model. The muscle, consisting of superficialis and profundus portions, is supplied by separate neurovascular systems. The vessels to pectoralis profundus (averaging 0.3 mm in diameter) can be taken in continuity with the axillary vessels (averaging 11 mm in diameter), which are used for transplantation. The profundus portion of muscle weighed an average of 1.8 g, and the average pedicle length was 0.9 cm. Nine of 11 transplanted muscles were viable, with intact circulation at 72 hours. An example of muscle transplantation for tissue defect coverage was attempted. The pectoralis profundus transplant was technically reliable, and the muscle bulk and contour could allow biochemical and functional studies. © 1994 Wiley‐Liss, Inc.
Preservation of the vasodilative effect of endothelium‐derived relaxing factor in the hind limb of the rat
Authors: Ono Hiroshi , Nakagawa Yoji , Tamai Susumu , Mizumoto Shigeru
Published: March 2007

Using an extracorporeal circulatory system of fresh blood, the vasodilative effect of endothelium‐derived relaxing factor (EDRF) secreted from vascular endothelium, stimulated by acetylcholine (ACh), was evaluated. The bioassay cascade technique was applied to elucidate the release of EDRF. Elevated blood pressure of freshly amputated rat hind limbs, created by injection of norepinephrine (NE), decreased by 56% with ACh infusion, suggesting the existence of EDRF in the peripheral vascular system of rat hind limbs. The vasodilative effect of EDRF could be preserved for at least 6 hours when stored at room temperature. The effect of EDRF decreased markedly following storage for more than 9 hours at room temperature and storage for more than 3 hours at 4°C. © 1994 Wiley‐Liss, Inc.
Spinal nerve root injuries in brachial plexus lesions: Basic science and clinical application of new surgical strategies. A review
Authors: Carlstedt Thomas P.
Published: March 2007

This paper reviews studies aimed at developing novel surgical means to correct functional deficits after spinal nerve root injuries in brachial plexus lesions. In a long series of animal experiments it has been possible to demonstrate re‐established connectivity between severed roots and the damaged spinal cord segment. This encouraging functional recovery by a new surgical strategy of managing ventral root avulsion injuries prompted clinical application, with restoration of activity. © Wiley‐Liss, Inc. © 1995 Wiley‐Liss, Inc.
Brachial plexus injury in Thailand: A report of 520 cases
Authors: Songcharoen Panupan
Published: March 2007

Between October 1984 and October 1993, 520 patients with traumatic brachial plexus injuries were treated at the Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok. There were 486 male and 34 female patients. Eighty‐two percent of the injuries were caused by motorcycle accidents, 9% by other traffic accidents, and 9% by gunshot, stabbing, and other means. The initial physical examination revealed 332 (63.8%) complete paralyses and 88 (36.2%) incomplete paralyses. One hundred twenty‐seven patients were treated conservatively, 43 patients were observed before definitive treatment was given, and 350 patients were treated by operative means. Four hundred and twenty‐one surgical procedures were performed, consisting of 314 neurotisations (250 spinal accessory, 14 plexo‐plexal, 21 intercostal, 21 phrenic, 4 cervical plexus, 1 long thoracic, and 3 neuromuscular), 38 neurolyses, 23 nerve grafting, 16 free muscle transfers combined with neurotisations, and 30 musculotendinous transfers. Motor functional recovery of patients followed up for more than 2 years was evaluated. Nerve grafting gave 82% good (more than MRC grade 3) and 18% fair and poor recovery. Neurolysis gave 69% good and 31% fair and poor recovery. In patients with neurotisation, the spinal accessory (to supra‐scapular, axillary, and musculocutaneous), intercostal (to musculocutaneous), phrenic (to suprascapular, axillary, and musculocutaneous), and plexo‐plexal methods gave a significant number of good results. © Wiley‐Liss, Inc. © 1995 Wiley‐Liss, Inc.
Value of a dynamic MR scan in predicting vascular ingrowth from free vascularized scapular transplant used for treatment of avascular femoral head necrosis
Authors: Fujisawa Kohzou , Hirata Hitoshi , Inada Hitoshi , Morita Akimasa , Takeda Kan , Hibasami Hiroshige
Published: March 2007

We have treated three patients with avascular osteonecrosis using vascularized scapular bone graft. To predict blood perfusion in both the diseased femoral head and the transferred bone, all the hips were followed up using dynamic magnetic resonance (MR) scans, performed 1 and 7 months after surgery. In the present cases, it was shown that conventional enhanced MR imaging sometimes depicts increased intensity in bone marrow without blood perfusion due to the leakage of gadolinium‐DTPA (Gd‐DTPA) from the capillaries surrounding the avascular tissue. It was found that Gd‐DTPA remaining in the dead bone marrow resulted in a false‐positive image. By contrast, the dynamic MR scan evaluated only those images taken before the leakage. This is one of the advantages of the dynamic study, which reflects actual blood flow in the bone. The fast rise in the time‐intensity curve following bolus injection of Gd‐DTPA indicates that there is fast blood perfusion in the bone. The dynamic MR scan has demonstrated that there is little blood perfusion in the diseased bone 1 month after the operation and that vascular ingrowth from the transferred bone flap proceeds gradually between 1 and 7 months after surgery. These findings indicate that the dynamic MR scan is very useful in demonstrating vascular ingrowth after surgery in avascular necrosis of the femoral head and can be a reliable monitoring technique for anastomotic patency of the vascularized bone flap. © 1995 Wiley‐Liss, Inc.
Experimental study on choline acetyltransferase activity measurement for brachial plexus injury
Authors: Yajima Hiroshi , Kawanishi Kouichi , Ohgushi Hajime , Tamai Susumu
Published: March 2007

We studied choline acetyltransferase (CAT) activity in a rat model of brachial plexus injury. In experiment 1, we found that the CAT activity was remarkably high in the anterior roots and low in the posterior roots. In experiment 2, nerve root segments were extracted and examined for CAT activity in the root avulsion group (group A) and the plexus severance group (group B). CAT activity decreased day by day in group A, reaching about 1/20 of the normal 5 days postoperatively. By contrast, in group B activity decreased only slightly, and even at 90 days postoperatively was about 6,000 cpm (one‐half normal level). As a result, CAT activity enabled us to distinghish postganglionic from preganglionic injury of the cervical roots. Furthermore, it was a useful adjunct for minimizing nerve loss in intercostal nerve transfer, distinguishing motor and sensory branches of the intercostal nerve, and evaluating the motor nerve activity. © 1995 Wiley‐Liss, Inc.
The versatility of free rectus femoris muscle flap: An alternative flap
Authors: Wei Ching‐Yueh , Chuang David Chwei‐Chin , Chen Hung‐Chi , Lin Chih‐Hung , Wong Sing‐Sieng , Wei Fu‐Chan
Published: March 2007

In the 10‐year period from June 1985 to December 1994, 54 free rectus femoris muscle or musculocutaneous flaps were performed at our hospital. It has been one of the most frequently used free muscle flaps in our institution and forms 2% of all free tissue transfers (total, 2,769 cases). In 26 patients, it was used for large wound coverage following debridement or tumor ablation, and in 27 patients, as a functioning free muscle transplantation for brachial plexus palsy or traumatic muscle loss. In one patient the components of the deep aponeurosis, muscle, and overlying skin were used for reconstruction of an abdominal wall defect after neurilemmoma excision. There were two complete failures, one due to diabetic foot infection and one due to venous occlusion. Four had superficial marginal skin necrosis. No significant disability of the donor limb was encountered. Easy approach, rapid harvest, large and reliable overlying skin flap, a single dominant neurovascular pedicle (with large vessel diameter and long motor nerve), easy primary closure of the donor site, and minimal donor site morbidity all make the rectus femoris flap a good alternative flap for free tissue transfer, in addition to the gracilis, rectus abdominis, and latissimus dorsi muscle flap. © 1995 Wiley‐Liss, Inc.
Simple monitoring technique for muscle flaps
Authors: Dagum Alexander B. , Dowd Andrew J.
Published: March 2007

A simple monitoring technique for the detection of postoperative arterial flow failure in muscle flaps is described. The technique consists of isolating a musculocutaneous perforator on elevation of a muscle flap. This cutaneous perforator is observed for pulsation in the postoperative period. Abrupt cessation prior to 48 hours should be an indicator for prompt clinical evaluation of the muscle flap by an experienced microsurgeon to rule out arterial thrombosis. © 1995 Wiley‐Liss, Inc.
Application of different types of free foot flaps in hand surgery
Authors: Li Xiaojun , Wang Yan , You Ruoxu
Published: March 2007

From 1987, nine types of free vascularized flaps or combined flaps from the foot were used to treat 26 cases of hand injury with tissue loss. They were: (1) combined flap of 4 toe dorsums, big toe pulp, first toe web, and dorsalis pedis flap with long extensor tendons of the toes, (2) composite skin flap with the second metatarsophalangeal joint, (3) wrap‐around flap from the great toe, (4) first toe web flap, (5) toe pulp flap with only an artery and a nerve, (6) wrap‐around flap of the great toe with a dorsalis pedis flap, (7) second toe with dorsalis pedis flap, (8) dorsalis pedis flap, and (9) first toe web flap with second metatarsal bone. All flaps survived. All the patients have used their reconstructed hand. Of the final motor functions of the reconstructed hands, 68.8% are excellent, 27.3% are good, 3.9% are fair. Of the final cosmetic results of the reconstructed hands, 76.9% are excellent, 15.3% are good, 7.8% are acceptable. Of the patients, 64.9% are satisfied with the final results of the donor sites, 31.2% feel it is acceptable, and 3.9% feel it is unsatisfactory. The selection, indication, merits and demerits of vascularized foot flaps and attentive points in the operations are discussed in this paper. © 1995 Wiley‐Liss, Inc.
Eight years experience in crush and avulsion type finger amputation
Authors: Özerkan Fuat , Ada Sait , Bora Arslan , Kaplan Ibrahim , Ademoĝlu Yalcin
Published: March 2007

Between July 1986 and July 1994, we studied 125 total finger amputations due to crush and avulsion type injuries at the lzmir Hand and Microsurgery Hospital. Of the 125 fingers replanted, 88 were successful, for a general survival rate of 70.4%. In the period between 1986 and 1991, we performed end‐to‐end anastomoses and achieved a survival rate of 48.3% (Group I). Between 1991 and 1994, with the application of a primary interpositional vein graft for the required indications in this type of injury, the general survival rate increased to 77.1% (Group II; P < 0.05). We conclude that the significant increase in the survival rate in Group II is related to both the increased experience of the surgical team and the application of the primary interpositional vein graft. © 1995 Wiley‐Liss, Inc.
Role of the perforating vein in vascular pedicle of free forearm flap
Authors: Tahara Shinya , Takagi Tadashi , Kinishi Minoru , Makino Kunihiko , Amatsu Mutsuo
Published: March 2007

An innovation in the preparation of the vascular pedicle of the free radial forearm flap is presented. While the radial artery is commonly used as the arterial pedicle of the flap, either the cutaneous venous system or the radial comitant vein (deep venous system) is used as the venous pedicle. The perforating vein communicates between these two venous systems at the cubital fossa, and we confirmed its presence in all but one of more than 180 cases. When the vascular pedicle is dissected proximally to the perforating vein contained in the flap, the venous drainage of both the deep and cutaneous systems can be restored by anastomosis of only one vein: the cutanous or the radial comitant vein. On the other hand, the flap can be raised with the radial vessels (without the cutaneous vein) at the start of surgery, and a large caliber cutaneous vein, such as the median cubital, the cephalic, or the basilic, can be used for anastomosis in cases where the cutaneous veins in the distal forearm are too thin, or where the radial comitant vein is composed of two thin separated veins. We believe that preserving the perforating vein would make the forearm flap more reliable and more convenient in reconstructive surgery. © 1995 Wiley‐Liss, Inc.
Effect of phosphate concentration in buffered irrigating solutions on arterial thrombosis
Authors: Brown David M. , Kania Norbert , Lantieri Laurent A. , Pasia E. Neil , Khouri Roger K.
Published: March 2007

The concentration of phosphate in buffered saline irrigation solutions was evaluated for its effect upon the incidence of arterial thrombosis. A rabbit thrombosis model of combined intimal abrasion and twisted pedicle in the rabbit central ear artery was used. Higher concentrations of phosphate (20 mM) in normal saline yielded a lower thrombosis rate at 7 days postoperatively (50%) in comparison to 5 mM phosphate (89% thrombosis rate; P<0.05). A standard phosphate‐buffered salt solution (Dulbecco's; 9.5 mM phosphate with potassium, calcium, and magnesium salts) also had a high thrombosis rate (91%). This study demonstrates that subtle variations in the irrigation solution can have profound effects upon arterial thrombosis. © 1995 Wiley‐Liss, Inc.
Rat strain differences in flap tolerance to ischemia
Authors: Deune E. Gene , Khouri Roger K.
Published: March 2007

The rat epigastric island flap model is commonly used to explore ischemia‐related phenomena. We sought to evaluate strain differences in tolerance to ischemia using two commonly used rat strains: Sprague‐Dawley and Lewis. Epigastric flaps (3 × 6 cm) based on the superficial epigastric artery and vein were raised bilaterally in each rat (2 flaps/rat). Ischemia was induced for 10, 12, 14, or 16 hours by placing temporary occlusion clamps on each vessel of the vascular pedicle. Surviving flap areas were assessed planimetrically after 7 days. The average area of surviving flap tissue was greater in the Lewis rats for all ischemia times; this achieved significance for 12 hours and 14 hours of ischemia (P<0.005). These findings indicate that comparisons among studies on rat flap ischemia must take into account the particular strain used. Furthermore, these findings suggest an inherent capacity of Lewis rat tissue to withstand ischemia better than tissue of the Sprague‐Dawley rat strain. © 1995 Wiley‐Liss, Inc.
Classification and comparison of five techniques of end‐to‐end microarterial anastomoses in rats: A new proposed technique
Authors: Gahankari Dilipkumar Ramesh , Lalwani Nimmi R. , Phatak Anuradha M.
Published: March 2007

We propose a new classification of five main techniques for microarterial anastomoses: interrupted, autogenous cuff, continuous, sleeve and partial sleeve. The last method was developed by the authors. A study was performed on 48 albino rats and comprised 20 anastomoses of each type (for a total of 100), performed on femoral and carotid arteries of average size 0.83 mm. These were compared with respect to patency, anastomosis time, leak, bleeding time, number of sutures (bites), microangiography, histopathology and scanning electron microscopy. The overall patency was 88%, and that of the partial sleeve technique was 100%, associated with 30% incidence of aneurysms. Clinical, histopathological and scanning electron microscopy findings showed better results for techniques with predominantly extraluminal sutures (sleeve and partial sleeve), which was particularly relevant in our situation, in which a larger sized needle (150 μm) had to be used. An overall aneurysm incidence of 17% was noted. © 1995 Wiley‐Liss, Inc.
Measurements of tissue blood flow by the hydrogen clearance technique (HCT): A comparative study including laser Doppler flowmetry (LDF) and the erlangen micro‐lightguide spectrophotometer (EMPHO)
Authors: Machens Hans‐Guenther , Pallua Norbert , Mailaender Peter , Pasel Jan , Frank Karl‐Heinz , Reimer Ralf , Berger Alfred
Published: March 2007

The purpose of this study was to compare the hydrogen clearance technique (HCT) with two different, well‐established techniques, i.e., the laser Doppler flowmetry (LDF) and the Eriangen micro‐lightguide spectrophotometer (EMPHO), for tissue blood flow measurements in an experimental setting. For the animal experiments, we chose a rat model for arterial and venous flap thrombosis, using the epigastric groin flap. Forty male dark Aguty rats were included in the study. The animals were divided into eight groups, each with a different vascular thrombotic model. HCT was used to collect 1,467 measurements, and 2,934 graphs were recorded; 27 measurements (54 graphs) had to be discarded due to faulty electrode placements and electronic noise. In 19 of the 27 discarded measurements the cause of failure was moving of the awaking animal with disruption of the decay signal. The LDF and EMPHO measurements were performed continuously during each measuring phase. Simple and multiple linear regression and paired t‐tests were used to compare the three techniques. The reproducibility of registered blood flow values in phases 1, 3, 6 and 7 varied between 7.8% and 13.6% which is in about the same range as LDF and EMPHO. We could not find a significant difference between the three techniques in this regard. The correlation coefficient for HCT and LDF was r = 0.89. For HCT and EMPHO we found r = 0.67. Sensitivity and specificity values for HCT were both 1.0 in detecting arterial and venous flap thrombosis; for LDF we found values of 0.89 and 0.92, respectively. Sensitivity and specificity values for EMPHO were 0.92 and 0.95, respectively. After careful evaluation of three different techniques (HCT, LDF, and EMPHO) for measurements of local tissue blood flow we came to the conclusion that HCT must be favoured as a reliable tool for quantitative measurement of local tissue blood flow and early diagnosis of arterial and venous flap thrombosis. © 1995 Wiley‐Liss, Inc.
Comparison of vascularised iliac crest and vascularised fibula transfer for reconstruction of segmental and partial bone defects in long bones of the lower extremity
Authors: Hierner Robert , Wood Michael B.
Published: March 2007

The results and complications of lower extremity bone reconstruction using microvascular fibula transfer were retrospectively compared with reconstruction using microvascular iliac crest transfer. Seventeen patients matched as much as possible in regard to location of defect (femur, tibia, ankle) and aetiology (traumatic defect, osteomyelitis) were studied in each group. Data collected included number of prior operative procedures, length of bony defect, presence or absence of associated soft tissue loss, the final clinical and radiographic result, technique of bone immobilisation and duration to union, complications including patency of microvascular anastomoses (if known) and nature and number of additional operative procedures. The outcome of this study suggests that, for reconstruction of the femur or tibia bridging a defect greater than 10 cms, fibula transfer yielded a satisfactory outcome. For defects less than 10 cms resulting from debridement for osteomyelitis, iliac crest transfer yielded a more favourable result. Moreover, the iliac crest appeared to be more optimal than the fibula for reconstruction about the ankle regardless of aetiology. © 1995 Wiley‐Liss, Inc.
Decision making and results in subtotal and total lower leg amputations: Reconstruction versus amputation
Authors: Hierner R. , Betz A. M. , Comtet J.‐J. , Berger A. C.
Published: March 2007

As a result of modern therapeutic and technological advances, the surgeon has the ability to salvage even the most severely injured lower limbs. However, the success of replantation nowadays is no longer measured simply on the basis of restoration of viability but also on functional outcome compared with primary amputation with early prosthetic fitting, the risk to the patient during and after replantation and the overall time of treatment which should not exceed 2 years. Although every major limb replantation has to be considered individually, the decision‐making process for reconstruction (replantation/revascularisation) versus amputation with subsequent early prosthetic fitting should be determined by objective criteria. Based on personal experience and an extensive literature search, an algorithm for treatment of amputation or amputation‐like injuries to the lower leg has been developed and tested in a clinical study. A 100% viability success rate was achieved. There was not only a significant increase in the percentage of “functional extremities” but also a doubling in grade I results. Moreover, there was a 50% reduction in patients presenting a “non‐functional extremity”, and no patient required a secondary re‐amputation. The replantation risk (e.g., risk of severe systemic disturbance during and/or after replantation) was about 16.6% (2/12) in our study. There was a significant decrease in the postoperative complication rate and no patient died during or after replantation. Based on our experience, if reconstruction in subtotal or total lower leg amputation is done for a well‐selected patient group, good functional results with a reasonable replantation risk and a reasonable time for social re‐integration can be achieved. © 1995 Wiley‐Liss, Inc.
Role of frenular penile‐brachial index in the assessment of penile vasculature
Authors: Nagler Harris M. , Katz P. Gary , White Ralph Devere
Published: March 2007

The evaluation for vasculogenic causes of impotence includes penile Doppler studies. These are often time‐consuming and tedious procedures. A retrospective study of the last 54 penile Doppler examinations was carried out to determine if an abbreviated study would accurately reflect the status of the penile vasculature. The frenular sound is easily auscultated. There is statistically significant correlation between frenular penile‐brachial index (PBI) and corporal PBI. We therefore recommend that the frenular PBI be used as a screening procedure. More complete Doppler studies including corporal measurements are only necessary when the frenular PBI is not normal.
Postprostatectomy urinary incontinence: Urodynamic assessment
Authors: Yalla Subbarao V. , Karsh Lawrence , Kearney Gary , Fraser Lionel , Finn Daniel , DeFelippo Noel , Dyro Frances M.
Published: March 2007

This communication deals with our urodynamic observations in 21 incontinent postprostatectomy patients. The factors causing incontinence were (1) persistent detrusor hyperactivity, (2) sphincter failure causing passive incontinence, and (3) a combination of the above two factors. None of the 21 subjects had any evidence of residual outlet obstruction.
Precise urodynamic assessment of meatal and distal urethral stenosis in girls
Authors: Griffiths D. J. , Scholtmeijer R. J.
Published: March 2007

Pressure/flow studies of micturition and urethral calibration have been carried out in some 100 girls, mean age 8.5 years, suffering from enuresis and/or recurrent urinary tract infections. By means of special urodynamic methods, including micturition with a thick urethral catheter that exaggerates the effect of urethral narrowing, a urodynamic caliber can often be assigned to any anatomic narrowing. This urodynamic caliber is closely related to the distal urethral or meatal caliber obtained with the bougie A boule, showing that both are measures of the same narrowing. In 68% of the girls the distal urethra and meatus are so wide that there is no urodynamically detectable obstruction even when the thick (8 FG) catheter is present. When the effect of the catheter is allowed for, only 3.5% of the girls show real anatomic obstruction, a further 7% being borderline. In our material the few urethras with a bougie a boule calibration of 14 FG are all urodynamically obstructed, and those calibrating at 16 FG are sometimes so. It has previously been shown that in this group of stenoses the results of dilatation are better than average, supporting the conclusion that a real anatomic obstruction has been relieved.
Micturitional static urethral pressure profilometry in women
Authors: Woodside Jeffrey R.
Published: March 2007

Micturitional static urethral pressure profilometry is an accurate method to identify the location and degree of bladder outlet and urethral obstruction in men. Described herein are the results of micturitional static urethral pressure profilometry in 17 women: 13 were nonobstructed, 3 were obstructed, and 1 voided by abdominal straining. The location of the static pressure drop was in the terminal urethral segment in all patients and was clearly distal to the location of the maximum urethral pressure determined on urethral closure pressure profilometry. It is concluded that the terminal urethral segment controls urinary flow, determines the voiding pressure, and that micturitional static urethral pressure profilometry can accurately identify the location of physiologic obstructions in the female urethra.
Momentum flux measurement in boys: A clinical evaluation
Authors: Griffiths D. J. , Scholtmeijer R. J.
Published: March 2007

Values of the momentum flux in the urinary stream and the urinary flow rate have been measured in 58 boys. The momentum flux is related to the flow rate as expected theoretically. The momentum flux is only weakly related to age and to the presence of detrusor instability. Patients with meatal stenosis tend to have a relatively high momentum flux, but the predictive value of momentum flux measurement is poor unless combined with a urodynamic study of micturition. We do not consider the measurement to have much clinical value in boys.
Detrusor instability in children
Authors: Griffiths D. J. , Scholtmeijer R. J.
Published: March 2007

In routine cystometric investigation of children complaining of enuresis and/or recurrent urinary tract infections, the incidence of apparent detrusor instability is high and only very weakly related to symptoms. It is not reproducible in repeated tests and is provoked by anxiety associated with the examination. By performing three successive cystometries at one sitting, while the child sits watching TV, we are able to reduce the anxiety and to identify a hard core of detrusors that are consistently unstable in all three tests. Consistent instability is related to symptoms. Among nocturnally enuretic boys, it is much more common in those who have additional daytime symptoms. Among girls, it is significantly more common among those complaining of enuresis than among those complaining of recurrent urinary tract infections. These results suggest that there are two types of enuresis, in only one of which detrusor instability is a contributory factor, and that detrusor instability is not associated with a history of repeated urinary tract infections. They show also that clinically significant information can be obtained by a simple cystometric method that can easily be carried out on an out‐patient basis.
Innervation of human penile blood vessels
Authors: McConnell Joann , Benson George S.
Published: March 2007

Nerve fibers and varicosities were localized with histochemical techniques in the tunica adventitia of human penile blood vessels. At the light microscopic level, these nerves were either adrenergic or acetylcholinesterase (AChE)‐positive. With the electron microscope, adrenergic, cholinergic, and possible peptidergic varicosities were found in these pen vascular nerves. The physiological effect of such a varied innervation of the penile vasculature in the processes of erection and detumescence and recent data on these processes are discussed.
The muscarinic cholinergic binding kinetics of the human urinary bladder
Authors: Levin Robert M. , Staskin David R. , Wein Alan J.
Published: March 2007

Determination of (1) the absolute number of cholinergic receptors, (2) the cholinergic binding kinetics, and (3) the direct antimuscarinic activity of a series of uropharmacologic agents was accomplished by radioligand binding techniques in tissue derived from human urinary bladder. The competition between 3H‐quinuclidinyl benzilate (3H‐QNB) binding and selective antagonists provided the first quantitative assessment of cholinergic receptor characteristics in the human bladder fundus and represents a potential method for assessing the antimuscarinic binding potential of uropharmacologic agents.
Complex repetitive discharges in the external urethral sphincter in a pediatric population
Authors: Dyro Frances M. , Bauer Stuart B. , Hallett Mark , Khoshbin Shahram
Published: March 2007

Complex repetitive discharges (CRDs) were seen in 26 patients undergoing urodynarnic studies. Eleven patients had myelodysplasia, 12 patients had urinary incontinence and/or urgency and/or recurrent urinary tract infections without evident neurologic abnormality, and 3 patients had spinal cord tumors. All exhibited abnormalities on urodynamic evaluation, either upper or lower motor neuron in type. Six girls with incontinence and CRDs had positive family histories, and these features define a possible genetic syndrome of delayed maturation of control over micturition.
Diagnosis of genuine stress incontinence—a comparison of the fluid bridge (flow) test and a pressure test
Authors: Anderson R. S. , Feneley R. C. L.
Published: March 2007

Two urodynamic investigations designed to make a diagnosis of genuine stress incontinence were compared in 103 women complaining of stress incontinence and 19 continent women. A fluid bridge (flow) test and a stress urethral pressure profile (using a microtip catheter system) were performed. Both tests gave similar results, confirming the diagnosis in 90% of the incontinent group.
The urethral pressure profile under stress: A comparison of profiles on coughing and straining
Authors: Hilton P.
Published: March 2007

In terms of urethral pressure measurements the distinction between stress‐incontinent and continent women is perhaps best made by examining the urethral response to stress. Profiles may be performed during the repeated intraabdominal pressure rises due to coughing, or the sustained effect of straining; the relationship between the two has not previously been defined. This comparative study involves 120 patients with a variety of urinary symptoms in whom stress profiles were performed both on coughing and on straining. Parameters of the cough profile were found to be more repeatable than those of the strain profile. and also related more closely to the severity of incontinence. Calculation of pressure transmission ratios from cough profiles also proved more useful. since they allow the acute and sustained components of the urethral response to stress to be readily distinguished.
Prostaglandins in lower urinary tract
Authors: Pavlakis Aristidis J. , Siroky Mike B. , Leslie Crystal A. , Krane Robert J.
Published: March 2007

The search for noncholinergic, nonadrenergic neurotransmitters in the lower urinary tract has recently focused on the prostaglandins (PG). Prostaglandin E2 (PGE2) and, to a lesser degree, prostaglandin FZα (PGFzα), are produced by the bladder in response to mechanical and nerve stimulation. In vitro stimulation of detrusor smooth muscle, using the same two compounds, produces a slow, prolonged contraction which is independent of nervous activity. In contrast, in urethral smooth muscle PGF2α causes contraction while PGE2 causes relaxation. Clinically, intravesical or intravenous administration of PGE2 or PGF2α may produce improved bladder tone or uninhibited contraction. Similarly, inhibitors of PG synthesis may produce improvement of unstable bladder.
Predictive value of voiding pressures in benign prostatic hyperplasia
Authors: Jensen Klaus M. E. , Bruskewitz Reginald C. , Iversen Peter , Madsen Paul O.
Published: March 2007

Sixty‐two patients with prostatism underwent a prospective and blinded evaluation to investigate the usefulness of preoperative measurement of opening, maximum intravesical, and detrusor pressures. Traditional urological methods, including detailed symptom analysis, cystoscopy, and excretory urography were used. In addition, all patients underwent urodynamic testing which entailed spontaneous uroflowmetry, medium‐fill water cysto‐rnetry, and pressure‐flow study. Forty‐three patients were reevaluated at three months and 28 patients at 12 months postoperatively. A weak correlation was found between the various voiding pressures and the symptom scores, flow rate, and minimum urethral resistance. Further analysis revealed that patients with normal preoperative pressures did as well postoperatively as patients with elevated preoperative pressures. No role for routine preoperative measurement of voiding pressures in patients with prostatism could be identified.
Clinical and urodynamic evaluation of the polypropylene (marlex) sling for genuine stress incontinence
Authors: Hilton Paul , Stanton Stuart L.
Published: March 2007

Ten women undergoing a polypropylene suburethral sling procedure for treatment of genuine stress incontinence were assessed pre‐ and post‐operatively by standard urodynamic methods and by urethral pressure profile measurements at rest and on stress. Eight patients were subjectively and seven objectively cured of stress incontinence. A significant reduction in urine flow rate was found although this appeared to be of little relevance to the successful outcome of surgery.

An increase in resting urethral profile length was seen in both successful and unsuccessful cases. The former also had an improvement in maximum urethral closure pressure on stress due to improvement in pressure transmission in the proximal three quarters of the functional urethral length. The urethra appeared relocated in a retropubic position following successful and unsuccessful operations. It is likely that failure was associated with periurethral fibrosis causing failure of pressure transmission despite adequate elevation.
Unsuspected meningocele presenting as neurogenic bladder dysfunction in an adult
Authors: Garbeff Peter J. , Barrett David M.
Published: March 2007

Two adult patients with neurogenic bladder dysfunction secondary to unsuspected meningoceles are described. The implications of such problems and the need for complete neurourologic evaluation are important.
Improved technique of combined ultrasonotomographic and urodynamic monitoring: Simultaneous displaying and videotaping of ultrasonotomography and urodynamic data in color
Authors: Nishizawa Osamu , Tsuchida Seigi , Harada Tadashi , Morita Takashi , Moriya Ltaru , Satoh Sadamoto , Ohya Akira , Nakamura Hisashi , Fukuda Takashi , Kin Nobukazu
Published: March 2007

We have previously reported a new method of video urodynamic examination combining urodynamic and ultrasonotomographic monitoring. A modified version of this combined urodynamic and ultrasonotomographic monitoring method is presented herein. Simultaneous ultrasonotomographic images and urodynamic data can be displayed in color on a color display monitor and videotaped with a video recorder, using a display controller, digital scan converter, and color encorder.
Isobaric volume registration in the assessment of detrusor instability
Authors: Fall Magnus , Erlandson Björn‐Erik
Published: March 2007

An alternative method to cystometry was used to investigate patients with unstable bladder. This method, isobaric volume registration, differs from cystometry by permitting recording of influences on the bladder during long periods of time at a constant intravesical pressure. Seventy‐five percent agreement between the two methods was found concerning the presence of uninhibited detrusor contractions, but the pressures and volumes at which instability appeared did not correspond with the two methods. Isobaric volume registration is not intended for use as a routine urodynamic investigation but is a useful complementary method in experimental studies to record detrusor responses to nerve and receptor stirnulation and blockade.
Urodynamic studies in the rabbit under the immobility reflex
Authors: Hassouna M. , Galeano C. , Abdel‐Rahman M. , Elhilali M.
Published: March 2007

We studied some urodynamic (UD) parameters in normal rabbits under immobility reflex (IR), without anesthesia. These parameters were compared after induction of anesthesia.

We found that anesthesia had a depressing effect on these UD parameters. IR is a good method for studying rabbits without the effect of anesthesia.
Residual urine, underactive detrusor function, and the nature of detrusor/sphincter dyssynergia
Authors: Griffiths D. J.
Published: March 2007

In a group of 280 patients with mixed pathology the adequacy of the detrusor contraction during voiding has been assessed by a new method. For the group as a whole, residual urine is nearly always the result of the fading away of the detrusor contraction and rarely of premature sphincter contraction. It is strongly associated with failure to attain an adequate detrusor contraction at any time during the micturition. The same is true both for children who show consistent urethral overactivity during voiding and for patients with detrusor/sphincter dyssynergia of neuropathic origin. The results suggest that in detrusor/sphincter dyssynergia or other types of urethral overactivity, it may be misleading to ascribe inefficient bladder emptying solely to the obstructive effect of the urethral closure mechanism; the underactive detrusor function should also be taken into account. Often there appears to be an incomplete activation of the micturition reflex, resulting in both incomplete stimulation of the detrusor and incomplete relaxation of the urethral closure mechanism.
Use of the evoked sacral potential in the evaluation of erectile impotence
Authors: Melman Arnold , Frye Suzanne
Published: March 2007

Forty‐six men with complaints of erectile dysfunction underwent multifaceted evaluations at our Center for Male Sexual Dysfunction. In addition, the evoked sacral potential (ESP) as a measure of the bulbocavernosus reflex was determined in each patient. The results were correlated with the final diagnoses obtained from the Center evaluation and analyzed. In nine patients a reproducible response could not be elicited. Of the remaining patients, 13 had abnormal and 24 had normal ESP responses. However, only 3 of the 13 patients who demonstrated abnormal ESPs were found to have organic impotence. Similarly, 10 of the 24 men with normal ESPs were thought to have organic impotence. Thus, a specific relationship between the ESP and erectile ability was not demonstrated. Therefore, the ESP is not useful in differentiating between organic impotence of neurogenic origin and psychogenic impotence.
Evidence against the presence of spare muscarinic receptors in the rabbit urinary bladder
Authors: Levin Robert M. , High Janice , Wein Alan J.
Published: March 2007

In a recent study by Anderson and Marks [1982], indirect evidence was presented for the existence of “150‐fold muscarinic receptor excess” in the rabbit urinary bladder. This conclusion was based on the quantitative comparison of the ability of carbamylcholine to both directly contract bladder strips and to inhibit (quinuclidinyl benzilate) binding. In order to investigate the presence of “spare receptors” in the bladder directly, we have determined the effect of benzilylcholine mustard (a noncompetitive cholinergic inhibitor) on both bethanechol stimulation of muscle‐strip contraction and on [3H]QNB binding (muscarinic receptor density). The results of these studies indicate that there is no significant “muscarinic receptor excess” in the rabbit urinary bladder.
Contractile effect of substance P on the canine urinary bladder in vivo
Authors: Norlén Lars J. , Blaivas Jerry G. , Grodin Warren , Lundberg Jan M.
Published: March 2007

Recent immunohistochemical studies have demonstrated a supply of polypeptides in neurons in many peripheral tissues including the lower urinary tract. The presence of substance P (SP) in the urinary bladder have been documented. In previous in vitro studies on isolated bladder muscle strips SP was found to have a contractory effect. In the present in vivo study intravesical pressure and arterial pressure were recorded following intraarterial administration of SP into six adult female dogs. Following administration of SP in doses of 0.1–0.75 μg/kg body weight (BW) no effect on intravesical pressure and a short‐lasting decrease in arterial blood pressure were recorded. Following SP in doses of 1–10 μg/kg BW an immediate and moderate increase in intravesical pressure and marked and longlasting decrease in intraarterial blood pressure were recorded. On the basis of the previous in vitro and immunohistochemical studies and the present in vivo study, the role of SP as a modulator of tone and motility of the urinary bladder should be considered.
Voiding in conscious spinal dogs induced by stimulating sacral and coccygeal roots with the “volume conduction” method
Authors: Tang Pei Chin , Walter James S.
Published: March 2007

A new method of stimulating the sacral and coccygeal roots was used to induce voiding in spinal dogs. The method consisted of inserting platinum stimulating electrodes through drilled holes in the dorsal surface of sacrum into the sacral canal in the vicinity of the spinal roots. Stimulation with this method was previously shown effective in inducing strong detrusor contraction and in completely emptying the bladder in anesthetized spinal dogs. In the present study, stimulation with this method was effective in completely emptying the bladder in both male and female conscious spinal dogs. This method appears to be safe as the two long‐termed spinal dogs were maintained healthy by emptying the bladder twice daily, the male for more than two years and the female for more than three years, until they were killed at the conclusion of the project. Unlike the conventional method, the electrodes in this method are replaceable. The safety and electrode replaceability of this method makes its future clinical use very attractive. The maximum urine output following a single stimulation increased several folds from an initial volume of 20 to 25 ml in three to four weeks.
Voiding in anesthetized spinal dogs induced by stimulating sacral and coccygeal roots with the “volume conduction” method
Authors: Tang Pei Chin , Walter James S.
Published: March 2007

In an attempt to avoid nerve injury, a new method of electrical stimulation of the innervations to the bladder has been developed. Stimulation with this method in 39 anesthetized spinal dogs induced a mean increase of 83.3 mmHg in intravesical pressure. Physiological reactions to stress were observed during stimulation with this method in anesthetized dogs but not in the same dogs after spinal transection. With a stimulating procedure designed to overcome the problem of sphincter contraction, the new method was found effective in emptying the bladder in anesthetized spinal dogs. The advantages of using this method are discussed and a comparison with the traditional method of stimulation indicates that this method could be less likely to cause nerve injury.