Adenylate cyclase and phosphodiesterase activity in rabbit ureter

Adenylate cyclase and phosphodiesterase enzyme activities were demonstrated in rabbit ureter. NaF, 10 mM, caused a 60.9 per cent increase in adenylate cyclase activity. Isoproterenol, 5 X 10-7 to 10-5 M induced a statistically significant dose-dependent increase in adenylate cyclase activity which was suppressed by propranolol, 10-7 M. Theophylline, 5 X 10-5 to 10-2 M, significantly inhibited phosphodiesterase activity. Thus, isoproterenol and theophylline, two agents that can relax ureteral segments previously contracted by a depolarizing concentration of potassium, could presumably increase cyclic AMP levels, isoproterenol by increasing synthesis and theophylline by decreasing degradation.

Venographic localization of the non-palpable undescended testis in children

In cases of bilateral non-palpable undescended testes in which human chorionic gonadotropin stimulation has shown the presence of testicular tissue and in cases of unilateral non-palpable undescended testes selective transfemoral gonadal venography with a modified Seldinger technique has been used for the preoperative localization of the non-palpable testis. since the undescended testis may be located anywhere along the course of its embryologic descent, that is from the level of the renal fossa to its exit from the inguinal canal, preoperative localization will aid in the surgical management. Gonadal venography has proved to be accurate and safe, and has aided in the determination of the extent of surgical exploration in 9 children with 12 non-palpable undescended testes (6 right and 6 left).

Comparative pressure-length-diameter relationships of neonatal and adult rabbit ureters

Pressure-length-diameter relationships of neonatal and adult rabbit ureters were studied in vitro. The increase in diameter, in response to an intraluminal pressure load of 10, 20, and 40 g per cm2, was faster and greater in the neonate than in the adult. Incubation in norepinephrine decreased the diametral deformation of neonatal ureters but had little effect on deformation in the adult ureter. The in vitro neonatal rabbit ureter, thus, appears to be more compliant and more sensitive to norepinephrine than the adult ureter.

Urethral closing pressure after spinal cord injury and its relationship to autonomic dysreflexia

The evolution of patterns of neurogenic vesical dysfunction with emphasis on urethral resistance has been studied using a two-catheter urethral profile technique in 24 patients following acute spinal cord injury. Inappropriate urethral resistance to voiding appeared to result both from smooth and skeletal muscular activity and to some extent was dependent on the level of the spinal cord lesion. Autonomic dysreflexia was common, and responded to treatment with an alpha-sympatholytic agent.

The obstructed bladder syndrome in the neonate

Eleven neonates with bladder obstruction, causing retention of urine, and a large, palpable lower abdominal mass were treated at the Yale-New Haven Hospital during a five year period. Intrinsic and extrinsic lesions, including urethral atresia, posterior urethral valves, ectopic ureteroceles, hydrocolpos and a neuroblastoma of the pelvis, were diagnosed by cystography, vaginography, pyelography and barium enema examination or a combination of these reoentgenographic methods. The multiplicity of underlying lesions make the obstructed bladder syndrome in the neonate a unique condition.

Seven-year survival of child with rhabdomyosarcoma of prostate

A case is reported of a twenty-two-month-old child who has survived for seven years without recurrence after multimodal therapy of a rhabdomyosarcoma of the prostate. The patient was treated with preoperative irradiation, radical surgery, and intraoperative and postoperative actinomycin D.

Time course of ureteral changes with obstruction

Chronic obstruction is characterized by a marked degree of ureteral dilatation and tortuosity which develops in the presence of a relatively low intraluminal pressure. To define the mechanism for the development of this relationship, the pressure-tension-deformation relationships of acute and chronically obstructed ureters were investigated. Rabbit ureters, in vivo, were obstructed and deformation correlated with intraluminal pressure. During the initial 3 h of obstruction, ureteral resting pressure increased from approximately 0 to 42 cm H2O, and diameter increased 16% with a slight increase in length. Subsequently, average wall tension (tensile stress) and intraluminal pressure declined, although deformation persisted. Between 6 h and 8 days after the onset of obstruction, intraluminal pressure remained essentially unchanged. During this time interval, ureteral deformation continued gradually and progressively as the ureter underwent creep both circumferentially and longitudinally. This was associated with a marked increase in average wall tension. At 8 days the diameter had increased by 170% and the length by 25%.

Urologic complications of inflammatory bowel disease

Urologic complications occurred in 54 of 233 patients with inflammatory bowel disease followed during a 15-year period. Urinary calculi, enterovesical fistulas and ureteral obstruction were the most common problems. Urinary tract complications may arise many years after primary bowel disease has been diagnosed. Symptoms frequently may be absent or obscured by those of the gastrointestinal disorder. We recommend that urologic evaluation be included periodically in the long-term management of patients with inflammatory bowel disease.

Management of urinary fistulas after renal transplantation

Urinary fistulas developed in 13 of 134 patients after renal transplantation. Bladder fistulas originating from the anterior suture line in 6 patients were satisfactorily managed by urethral or paravesical drainage. Fistulas arising from the donor ureter were best treated by surgical repair using the recipient's own ureter. Caliceal fistulas in 3 patients were successfully treated with nephrostomy drainage. A favorable outcome was achieved in 11 of the 13 patients, with closure of the fistula and preservation of renal function.

Reflux and trapping

Although functional ureteral obstruction results in a decrease in the rate of antegrade urine flow, urine may still traverse the obstructed segment in a retrograde direction. Decreased musculature is found in the obstructing area. The combination of these processes results in reflux with trapping. This process has been demonstrated radiographically at both the ureterovesical and the ureteropelvic junctions.

Treatment of autonomic dysreflexia with phenoxybenzamine

Our 9 patients with severe autonomic dysreflexia treated with phenoxybenzamine, an alpha-sympatholytic agent, had a dramatic relief of symptoms. Bladder and urethral pressure studies before and after treatment with this agent suggest that the inappropriate rise in urethral resistance in these patients is a result of an appropriate but extraordinary response to bladder filling.

Serum diiodotyrosine

Serum diiodotyrosine (DIT) was measured by radioimmunoassay in healthy subjects patients with thyroid disease and a variety of laboratorty animals. Ninety-two healthy adults had a mean level of 101 ng/100 ml. There was no sex difference in DIT levels but DIT fell with aging. There was no change with short term oral SSKI administration. Athyrotic subjects had measurable but reduced levels (mean = 52 ng/100 ml). Hyperthyroid subjects had levels slightly, but not significantly, higher than controls (mean = 149 ng/100 ml). Treatment of hyperthyroidism was followed by a small but significant fall in DIT levels, but there was no change in DIT levels with thyroid hormone therapy of hypothyroidism. A large species variation in serum DIT levels was found among laboratory animals with mean levels ranging from 17 ng/100 ml in mice to 428 ng/100 ml in dogs.

Pressure measurements in ileal conduits

To study the dynamic properties of ileal conduits and to attempt to diagnose obstruction at an early point in time, that is prior to the development of conduit or upper urinary tract dilatation, a continuously perfused catheter technique was used to measure pressures within the conduit during filling and emptying, and to measure the resistance to flow at the stomal level. The mean values of residual urine, resting pressure, voiding pressure and stomal profile pressure were significantly higher in obstructed than in non-obstructed conduits. However, there was an overlap between values in each parameter, thus necessitating analysis of the entire pressure data in any given case. The data also show that even a small increase in residual urine above normal, 4.0 plus or minus 0.9 cc, may be an indication of early obstruction and that stomal caliber does not necessarily correlate with the degree of obstruction.

Secondary bladder neck obstruction in patients with urethral valves: Treatment with phenoxybenzamine

Two cases are reported of functionally significant bladder neck obstruction following urethral valve fulguration which resulted in inability to void. Both patients responded to the administration of phenoxybenzamine, an alpha-adrenergic blocking agent. Treatment of patients with suspected bladder neck obstruction with this agent provides a reversible method of decreasing urethral resistance without the potentially harmful effects of surgical bladder neck revision.

Palliative urinary diversion for pelvic malignancy

Palliative urinary diversion was done in 47 cases for ureteral obstruction secondary to advanced pelvic malignancy. The average survival time was 5.3 months, with only 50 per cent of the patients alive at 3 months and only 22.7 per cent alive at 6 months. After the diversion 63.8 per cent of the survival time was spent in the hospital. Patients with carcinoma of the prostate fared better than those with other sites of tumor origin, which may reflect the natural history of this tumor.

A multiple ligand-binding radioimmunoassay of diiodotyrosine

A radioimmunoassay has been developed for the measurement of 3,5-diiodo-L-tyrosine (DIT) in serum. DIT was coupled to porcine thyroglobulin (PTg) with a molar ratio of 205:1. Rabbits were immunized with 1 mg of immunogen emulsified in complete Freund's adjuvant. Sera were screened for their ability to bind trace amounts of [125I]DIT. A serum that bound 40% of the tracer at a final dilution of 1:1,750 was used in the assay. Assay specificity was improved by the use of thyroxine (T4)-binding globulin as a second ligand-binding protein to decrease T4 and triiodothyronine (T3) cross-reactivity with the antibody. Double antibody and polyethylene glycol radioimmunoassays were compared. DIT present in the second antiserum shifted the double antibody assay standard curve and altered estimates of assay specificity and assay sensitivity. By using the polyethylene glycol system and butanol:ethanol extracts of serum, DIT was measured in human serum. In 35 apparently healthy young adult controls DIT levels averaged 156 ng/100 ml. Random DIT levels averaged 158 ng/100 ml in 11 untreated hyperthyroid patients and 84 ng/100 ml in 15 untreated primary hypothyroid patients. No diurnal pattern in DIT levels could be demonstrated. Thyroid-stimulating hormone administration led to a variable but small rise in DIT levels, but short term T3 suppression was not associated with a measurable fall in DIT concentrations. Paired serum samples from the carotid artery and thyroid vein of 10 euthyroid goiter patients and one patient with a toxic solitary adenoma all showed a positive transthyroidal gradient indicating the thyroidal release of DIT in each patient. Measurable DIT levels of 45, 47, 68, and 80 ng/100 ml, respectively, were found in four fasting athyrotic patients indicating that the thyroid is not the only source of serum DIT.