Cyclic voiding urosonography for detecting vesicoureteric reflux in renal transplant recipients.
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BACKGROUND: The clinical significance of vesicoureteric reflux (VUR) in renal transplant recipients remains controversial. Voiding urosonography (VUS), a new modality for detecting VUR, can be used in these patients. The sensitivity of X-ray and radionuclide cystography for detecting VUR may be improved with cyclic procedures. The aim of our study was to evaluate whether cyclic VUS is superior to the single-cycle procedure. METHODS: Cyclic VUS was performed in 27 renal transplant recipients. Eight were children or adolescents and the remaining 19 recipients were adults. VUS was performed according to accepted guidelines. After the first micturition, the catheter was left in place and the entire procedure was repeated under the same conditions. RESULTS: Both initial cycle and cyclic VUS detected 17 out of 27 (63%) VURs in the same patients. The sensitivity was not improved by cyclic VUS. However, there were differences between the initial cycle and cyclic VUS (P=0.028) when comparing the number of negative results and the grades of VURs detected. This difference was even more pronounced when analysing only positive results. In the initial cycle, five out of 17 (29%) VURs were grade III, compared with 10 out of 17 (59%) grade III VURs in the same patients using the cyclic procedure (P=0.008). CONCLUSIONS: Cyclic VUS did not improve the detection sensitivity for VUR in our study. However, given that VUR grade may be important for the management of renal transplant recipients, the use of cyclic VUS may provide a useful diagnostic tool for these patients. (+info)
Afferent fibers of the hypogastric nerves are involved in the facilitating effects of chemical bladder irritation in rats.
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To evaluate the role of bladder afferent fibers in the hypogastric nerves (HGN) in modulation of the micturition reflex induced by chemical bladder irritation, voiding behavior, continuous cystometry, and spinal c-fos expression following intravesical acetic acid instillation were investigated in rats with or without HGN transection. Voiding behavior and continuous cystometry were examined in unanesthetized conscious rats. Following chemical bladder irritation, a significant increase in urinary frequency associated with a marked decrease in the voided volume per micturition, was noted in control rats with the intact HGN, but not in HGN-transected rats. Continuous infusion of acetic acid in control rats elicited irritative bladder responses characterized by a marked decrease in the intercontraction interval and a marked increase in maximal vesical pressure, both of which were absent in capsaicin-desensitized rats. HGN transection prevented the decrease in the intercontraction interval but not an increase in maximal vesical pressure following chemical bladder irritation. Compared with saline infusion, acetic acid infusion caused a significant increase in c-fos expression at L(1) and L(6) of the spinal cord, and HGN transection significantly reduced c-fos expression in the dorsal horn of the spinal cord at L(1) but not at L(6). These results suggest that capsaicin-sensitive bladder afferent fibers in the HGN, which travel through the rostral lumbar spinal cord, have a role in urinary frequency caused by chemical bladder irritation. (+info)
Panic disorder among Vietnamese refugees attending a psychiatric clinic: prevalence and subtypes.
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This study surveys Vietnamese refugees attending two psychiatric clinics to determine both the prevalence of panic disorder (PD) as well as panic attack subtypes in those suffering PD. A culturally valid adaptation of the SCID-panic module (the Vietnamese Panic Disorder Survey or VPDS) was administered to 100 Vietnamese refugees attending two psychiatric clinics. Utilizing culturally sensitive panic probes, the VPDS provides information regarding both the presence of PD and panic attack subtypes during the month prior to interview. Of 100 patients surveyed, 50 (50%) currently suffered PD. Among the 50 patients suffering PD, the most common panic attack subtypes during the previous month were the following: "orthostatic dizziness" (74% of the 50 panic disorder patients [PDPs]), headache (50% of PDPs), wind-induced/temperature-shift-induced (24% of PDPs), effort-induced (18% of PDPs), gastro-intestinal (16% of PDPs), micturition-induced (8% of PDPs), out-of-the-blue palpitations (24% of PDPs), and out-of-the-blue shortness of breath (16% of PDPs). Five mechanisms are adduced to account for this high PD prevalence as well as the specific profile of subtypes: 1) a trauma-caused panic attack diathesis; 2) trauma-event cues; 3) ethnic differences in physiology; 4) catastrophic cognitions generated by cultural syndromes; and 5) a modification of Clark's spiral of panic. (+info)
Mechanism of FK506-induced renal hypoperfusion and its reversion in rats.
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AIM: To investigate the mechanism of renal hypoperfusion induced by tacrolimus (FK506) and to test the related agents acting against the process. METHODS: Experiments were performed in 6 groups of isolated perfused rat kidneys (IPRK). The parameters of renal function and the concentration of endothelin in the perfusate and urine were assessed at an interval of 15 min. Four groups of IPRK were perfused with normal saline and varied concentrations of FK506 (10 nmol/L-10 micromol/L) to set up a control and a hypoperfusion model. The other 2 groups were used as hypoperfusion models to test the actions of endothelin receptor antagonist FR139317 and calcium channel blocker diltiazem. RESULTS: Hypoperfusion model was established in IPRK by adding FK506 10 micromol/L in the perfusate, with the significant decreases of perfusate flow rate (PFR) and glomerular filtration rate (GFR), the significant increase of perfusion resistance (PR) and the concomitant increase of endothelin in perfusate and urine (P < 0.01). When FR139317 was added into the perfusate, only the depressed GFR was improved (P < 0.05) while the increased PR was not (P > 0.05). However, the addition of diltiazem reversed both the increase of PR and the decrease of GFR completely (P < 0.01). CONCLUSION: Endothelin is likely to play an important role in the pathogenesis of FK506-induced acute renal hypoperfusion. Diltiazem can completely prevent the renal hypoperfusion induced by FK506 in IPRK. (+info)
Urinary flow and flow pattern in paralegics.
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In 34 paraplegics with neurogenic bladder dysfunction 108 uroflowmetries were performed using the uroflowmeter described by Garrelts and Strandell. Paraplegics show according to their pathophysiology of bladder emptying characteristic flow pattern. Their urinary flow rates are diminished. The decrease as compared with healthy people is nearly similar for patients with automatic and with autonomous areflexic bladders. Some pathophysiological aspects for these findings are discussed. One may conclude that decreased urinary flow and altered flow pattern, as changes of urodynamics in general, can be regarded as one of the factors causing recurrent bacteriuria and urinary infections in paraplegics. (+info)
Adpatations for urinary marking in rodents: prepuce length and morphology.
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Urine marking was examined in house mice, deermice, gerbils and hamsters. The frequency of urine deposition varied with the species, and a correlation is suggested between the propensity of males to mark in this fashion and prepuce length and morphology. We postulate an adaptational advantage for a long penis sheath and for a particular configuration of the prepuce; i.e. to act as a wick for the deposition of urinary pheromones. (+info)
Nitric oxide blockade enhances renal responses to superoxide dismutase inhibition in dogs.
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To examine the potential role of superoxide anion (O(2)(-)) and its interaction with NO in the regulation of renal hemodynamics and excretory function, we have evaluated the renal responses to enhancement in O(2)(-) activity before and during NO synthase inhibition in anesthetized dogs (n=6). Intraarterial infusion of a superoxide dismutase (SOD) inhibitor, diethyldithiocarbamate (DETC; 0.1 and 0.5 mg/kg per min) was made to enhance O(2)(-) activity in the kidney. Cortical (CBF), medullary (MBF), and total renal blood flow (RBF) responses were assessed using laser-Doppler needle flow probes and an electromagnetic flow probe. DETC caused dose-dependent changes in renal parameters, which were recovered within 30 minutes after the termination of DETC infusion. The high-dose infusion of DETC for 25 minutes resulted in an increase of 29 +/- 10% in renal vascular resistance (control, 35.4 +/- 4.4 mm Hg/mL per min per g) and decreases of 21 +/- 5% in RBF (control, 3.5 +/- 0.5 mL/min per g), 20 +/- 5% in CBF, 21 +/- 7% in MBF, 62 +/- 11% in urine flow (control, 10.5 +/- 2.2 microL/min per g), and 47 +/- 11% in sodium excretion (control, 2.1 +/- 0.2 micromol/min per g), without a significant change (-10 +/- 6%) in glomerular filtration rate (control, 0.74 +/- 0.09 mL/min per g). During NO synthase inhibition with intraarterial administration of nitro-L-arginine (50 microg/kg per min), the same dose of DETC showed a greater increase in renal vascular resistance (73 +/- 15%) and reductions in RBF (39 +/- 4%), CBF (32 +/- 5%), MBF (34 +/- 6%), urine flow (78 +/- 5%), and sodium excretion (67 +/- 0%), with a marked reduction in glomerular filtration rate (59 +/- 7%). These data indicate that O(2)(-) exerts renal vasoconstriction as well as antidiuretic and antinatriuretic effects. These responses are enhanced during NO synthase blockade, suggesting that NO serves a renoprotective effect against these action of O(2)(-). (+info)
Volume kinetics of glucose solutions given by intravenous infusion.
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Glucose solutions given by intravenous (i.v.) infusion exert volume effects that are governed by the amount of fluid administered and also by the metabolism of the glucose. To understand better how the body handles glucose solutions, two volume kinetic models were developed in which consideration was given to the osmotic fluid shifts that accompany the metabolism of glucose. These models were fitted to data obtained when 21 volunteers who were given approximately 1 litre of glucose 2.5 or 5% or Ringer's solution (control) over 45 min. The maximum haemodilution was similar for all three fluids, but it decreased more rapidly when glucose had been infused. The volume of distribution for the infused glucose molecules was larger (approximately 12 litres) than for the infused fluid, which amounted to (mean (SEM)) 3.7 (0.3) (glucose 2.5%), 2.8 (0.2) (glucose 5%), and 2.5 (0.2) litres (Ringer). Fluid accumulated in a remote (cellular) body fluid space when glucose had been administered (approximately 0.2 and 0.4 litres, respectively), while expansion of an intermediate fluid space (7.1 (1.3) litres) could be demonstrated in 33% of the Ringer experiments. In conclusion, kinetic models were developed which consider the relationship between the glucose metabolism and the disposition of intravenous fluid. One of them, in which infused fluid expands two instead of three body fluid spaces, was successfully fitted to data on blood glucose and blood haemoglobin obtained during infusions of 2.5 and 5% glucose. (+info)