Voiding Dysfunction Associated with Pudendal Nerve Entrapment

Pudendal nerve entrapment (Alcock canal syndrome) is an uncommon source of chronic pelvic pain, in which the pudendal nerve is entrapped or compressed. Pain is located in the perineal, genital and perianal areas and is worsened by sitting. By simple entrapment of the PN without neurogenic damages, pain is usually isolated. In neurogenic damages to the PN, genito-anal numbness, fecal and/or urinary incontinence can occurred. PNE can be caused by obstetric traumas, scarring due to genitoanal surgeries (prolaps procedures!), accidents and surgical mishaps. Diagnosis is based on anamnesis, clinical examination including vaginal or rectal palpation of the pelvic nerves with selective nerve blockade. Pudendal pain non systematic mean PNE since other neuropathies may induce pudendal pain. So sacral radiculopathies (sacral nerves roots S#2-4) are underestimated etiologies frequently responsible for pudendal pain with irradiation in sacral dermatomes, bladder hypersensitivity or in neurogenic lesions, bladder retention.

Ethnic, racial and cultural identity and perceived benefits and barriers related to genetic testing for breast cancer among at-risk women of African descent in New York City

BACKGROUND

Due to disparities in the use of genetic services, there has been growing interest in examining beliefs and attitudes related to genetic testing for breast and/or ovarian cancer risk among women of African descent. However, to date, few studies have addressed critical cultural variations among this minority group and their influence on such beliefs and attitudes.

METHODS

We assessed ethnic, racial and cultural identity and examined their relationships with perceived benefits and barriers related to genetic testing for cancer risk in a sample of 160 women of African descent (49% self-identified African American, 39% Black-West Indian/Caribbean, 12% Black-Other) who met genetic risk criteria and were participating in a larger longitudinal study including the opportunity for free genetic counseling and testing in New York City. All participants completed the following previously validated measures: (a) the multi-group ethnic identity measure (including ethnic search and affirmation subscales) and other-group orientation for ethnic identity, (b) centrality to assess racial identity, and (c) Africentrism to measure cultural identity. Perceived benefits and barriers related to genetic testing included: (1) pros/advantages (including family-related pros), (2) cons/disadvantages (including family-related cons, stigma and confidentiality concerns), and (3) concerns about abuses of genetic testing.

RESULTS

In multivariate analyses, several ethnic identity elements showed significant, largely positive relationships to perceived benefits about genetic testing for breast and/or ovarian cancer risk, the exception being ethnic search, which was positively associated with cons/disadvantages, in general, and family-related cons/disadvantages. Racial identity (centrality) showed a significant association with confidentiality concerns. Cultural identity (Africentrism) was not related to perceived benefits and/or barriers.

CONCLUSIONS

Ethnic and racial identity may influence perceived benefits and barriers related to genetic testing for breast and/or ovarian cancer risk among at-risk women of African descent. Genetic counseling services may want to take into account these factors in the creation of culturally-appropriate services which best meet the needs of this heterogenous population.

Genetic counselor opinions of, and experiences with telephone communication of BRCA1/2 test results

BRCA1/2 test disclosure has, historically, been conducted in-person by genetics professionals. Given increasing demand for, and access to, genetic testing, interest in telephone and Internet genetic services, including disclosure of test results, has increased. Semi-structured interviews with genetic counselors were conducted to determine interest in, and experiences with telephone disclosure of BRCA1/2 test results. Descriptive data are summarized with response proportions. One hundred and ninety-four genetic counselors completed self-administered surveys via the web. Although 98% had provided BRCA1/2 results by telephone, 77% had never provided pre-test counseling by telephone. Genetic counselors reported perceived advantages and disadvantages to telephone disclosure. Thirty-two percent of participants described experiences that made them question this practice. Genetic counselors more frequently reported discomfort with telephone disclosure of a positive result or variant of uncertain significance (p < 0.01) than other results. Overall, 73% of participants reported interest in telephone disclosure. Many genetic counselors have provided telephone disclosure, however, most, infrequently. Genetic counselors identify potential advantages and disadvantages to telephone disclosure, and recognize the potential for testing and patient factors to impact patient outcomes. Further research evaluating the impact of testing and patient factors on cognitive, affective, social and behavioral outcomes of alternative models of communicating genetic information is warranted.

Ligated chlorophyll cation radicals: Their function in photosystem II of plant photosynthesis

Magnesium tetraphenylchlorin, a synthetic model for chlorophyll, exhibits significant variations in the unpaired spin densities of its cation radicals with concomitant changes in oxidation potentials as a function of solvent and axial ligand. Similar effects are observed for chlorophyll (Chl) a and its cation radicals. Oxidation potentials for Chl --> Chl(+.) as high as +0.9 V (against a normal hydrogen electrode) are observed in nonaqueous solvents, with linewidths of the electron spin resonance signals of monomeric Chl(+.) ranging between 9.2 and 7.8 G in solution. These changes in electronic configuration and ease of oxidation are attributed to mixing of two nearly degenerate ground states of the radicals theoretically predicted by molecular orbital calculations. Comparison of the properties of chlorophyll in vitro with the optical, redox, and magnetic characteristics attributed to P-680, the primary donor of photosystem II which mediates oxygen evolution in plant photosynthesis, leads us to suggest that P-680 may be a ligated chlorophyll monomer whose function as a phototrap is determined by interactions with its (protein?) environment.

The cation radicals of free base and zinc bacteriochlorin, bacteriochlorophyll, and bacteriopheophytin

One-electron oxidation of zinc tetraphenylbacteriochlorin and its metal-free base yielded stable cation radicals. Electron spin resonance hyperfine splittings were assigned by selective deuterations. These results indicate that the protons of the saturated rings of the bacteriochlorins carry large spin densities, in accord with molecular orbital calculations. Comparison in vitro of the optical spectra of bacteriochlorins and their cation radicals with those of bacteriochlorophyll show close correspondence and suggest that the electron spin resonance data from the former may also prove a guide to the biological molecule. The surprising similarity in properties between the radicals of free base and zinc bacteriochlorins is maintained in the chlorophylls: cation radicals of bacteriopheophytin and methyl pheophorbide (the free bases of bacteriochlorophyll and methyl chlorophyllide, respectively) exhibit electron spin resonance properties similar to those of their magnesium-containing derivatives. The possibility that metal-free chlorophylls participate in photosynthesis is discussed.

Effects of calcium channel blockers on the female genital tract

Contractile activity and vascular resistance in the female genital tract are influenced by several smooth muscle tissues with individual mechanisms for control of mechanical activation. Calcium channel blockers have potent relaxant effects on preparations of human myometrium. The myometrial arteries utilize multiple sources of calcium for contractile activation, and excitation-contraction coupling in isolated vessels from non-pregnant uteri seems comparatively less sensitive to nifedipine than in corresponding myometrial preparations. Contractile activation of myometrial and placental arteries at term is inhibited by nitrendipine and nifedipine. Human oviductal smooth muscle depends on superficially bound calcium for mechanical activation, but only phasic contractions can be abolished by nifedipine, while tonic contractions induced by various agents are more resistant to the calcium channel blocker. Menstrual uterine contractions and pain are effectively counteracted by nifedipine in normal and dysmenorrhoeic women. Such therapy may represent an alternative principle in the treatment of dysmenorrhea. Nifedipine has potent relaxant effects on the mid-term pregnant and the post-partum uterus and calcium channel blockers may prove useful in the treatment of premature labor. Nifedipine and related compounds may further show effective in the treatment of pregnancy-associated hypertension. Whether such treatment in late pregnancy involves maintained or even improved placental perfusion could be assumed from in vitro data but needs further studies.

Effects of calcium channel blockers on urinary tract smooth muscle

Influx of calcium from the extracellular medium seems to be important for spontaneous as well as agonist-induced contractile activity in urinary tract smooth muscle. To a various extent this calcium influx occurs through pathways which can be blocked by calcium channel blockers. These drugs effectively suppress spontaneous ureteral activity in vitro. Whether they affect ureteral motility in vivo or whether they can counteract ureteral spasm associated with ureteral stones have not been established. Calcium channel blockers partially block electrically as well as agonist-induced detrusor contractions. Some of these drugs abolish even atropine-resistant contractile responses induced by electrical stimulation in detrusor muscle. Drugs with combined antimuscarinic and calcium channel blocking effect therefore have an attractive effect profile. Experiences with calcium channel blockers in the treatment of patients with 'unstable bladder' are limited, but results obtained with terodiline seem promising. Even if calcium channel blockers reduce agonist-induced contraction in isolated urethral muscle, their clinical effect on urethral function seems to be small. The effects of calcium blockers on urinary tract smooth muscle may be clinically useful and deserve further study.

Effects of prostaglandins on the smooth muscle of the urinary tract

A short review is given of the effects of prostaglandins on the smooth muscle of the bladder, urethra and ureter. In several animal species and in man, prostaglandins of the E and F types contract the detrusor. The contractions develop slowly and are not affected by tetrodotoxin, phenoxybenzamine, or atropine, suggesting a direct effect on the smooth muscle cell. However, evidence is also available suggesting a role of the prostaglandins as modulators of transmitter release in the bladder. In animals as well as in man, urethral smooth muscle is contracted by prostaglandin F2alpha, but relaxed by prostaglandins E1 and E2. The smooth muscle of the ureter seems to react similarly, but published results vary. The detailed mode of action, and the role of prostaglandins in the control of activity in urinary tract smooth muscle remain to be established.

Expression of the epidermal growth factor system in eutopic endometrium from women with endometriosis differs from that in endometrium from healthy women

BACKGROUND

The epidermal growth factor (EGF) system comprises four receptors, HER1-4, and several ligands, and is cyclically expressed in endometrium from healthy fertile women. Our aim is to identify differences in expression of the EGF system between endometriotic and normal endometrium.

METHODS

We previously examined the EGF system in endometrial samples from healthy women (n = 14). Here we examine samples from endometrium (n = 23), endometriomas (n = 10) and peritoneal endometriosis (n = 9) from women with endometriosis (n = 23). mRNA expression of receptors and ligands from the EGF system was analyzed by real-time PCR, and proteins were localized by immunohistochemistry.

RESULTS

Endometrial mRNA for HER1-3 was high compared with our previous findings in healthy endometrium, whereas HER4 and the ligands were unchanged. Endometriomas show lower expression of HER1-3 and no HER4 expression. Significant differences were demonstrated in late secretory phase for HER1 and HER2 and in the proliferative phase for HER3 compared to healthy women. Immunohistochemically, HER2 was identified in all samples, predominately in glands and surface epithelium. In a few glands, HER2 was in both cytoplasm and cell membrane.

CONCLUSION

We report quantitative and qualitative differences in the EGF system in endometriotic eutopic endometrium compared to endometrium from healthy individuals.

Expression of the epidermal growth factor system in endometrioid endometrial cancer

OBJECTIVE

The Epidermal Growth Factor (EGF) system is expressed in healthy premenopausal endometrium. We describe the expression of the four receptors, HER1, HER2, HER3, HER4 and the six ligands amphiregulin, transforming growth factor alpha (TGF-alpha), heparin binding EGF like growth factor (HB-EGF), betacellulin, epiregulin and EGF in endometrioid endometrial cancer.

METHODS

We have uterine samples from 45 women with endometrioid endometrial cancer. As normal counterparts, endometrial samples from thirteen postmenopausal women, and previous data on fourteen premenopausal women were employed. Extracted RNA was analyzed by real-time PCR; the receptors and ligands were localized by immunohistochemistry.

RESULTS

Three receptors (HER1, HER2 and HER4) and two detectable ligands (TGF-alpha and HB-EGF) are expressed significantly higher in endometrial cancer than in healthy postmenopausal endometrium. Cancer tissue show significantly lower expression of HER1 and HER3, and higher expression of HER4, amphiregulin, TGF-alpha and HB-EGF compared to premenopausal endometrium; no difference is seen in HER2. EGF is undetectable in all of the samples. Immunohistochemically the receptors locate to the epithelium and/or glands while the ligands locate to the stroma (amphiregulin), the stroma and the epithelium (TGF-alpha, epiregulin), the epithelium (betacellulin) or are not detectable (HB-EGF, EGF).

CONCLUSIONS

mRNA of all receptors and five ligands are present in endometrioid endometrial cancer, and the protein of all receptors and four ligands are identified by immunohistochemistry. The expression pattern in endometrioid endometrial cancer differs from the pattern in pre- and postmenopausal endometrium. The most remarkable finding is an increased level of HER4, a receptor which correlates to a favorable prognosis in other types of cancers.

Expression of the epidermal growth factor system in human endometrium during the menstrual cycle

The epidermal growth factor (EGF) system is ubiquitous in humans and plays fundamental roles in embryogenesis, development, proliferation and differentiation. As the endometrium of fertile women is characterized by proliferation and differentiation, we hypothesize a role for the EGF system. Fourteen premenopausal women had endometrial samples removed on day 6 +/- 1 and day 6 +/- 1 and 12 +/- 1 after ovulation during one menstrual cycle. RNA was extracted and analysed by real-time PCR, and immunohistochemistry was performed to localize the components of the EGF system. Human EGF Receptor 1 (HER1) showed highest expression during the proliferative phase, HER2 and HER4 during the early and HER3 during the late secretory phase. Amphiregulin (AR) and transforming growth factor alpha (TGFalpha) expression is highest in proliferative phase. Heparin binding (HB)-EGF and betacellulin (BCL) show no variation. Epiregulin (EP) is detectable in some samples. EGF is undetectable. HER1, HER2, HER3 and HER4 were localized to the epithelium and glands HER3 and HER4 solely in the secretory phase. Amphiregulin was seen in leucocytes and stromal cells, TGFalpha and betacellulin in the epithelial lining, epiregulin in stromal cells whereas HB-EGF and EGF are undetectable. In conclusions, we observed cyclical expression of the four EGF receptors and two ligands and localized all four receptors and four ligands in endometrial biopsies. This suggests a role for the EGF system in growth of the endometrium.

KATP-channel-induced vasodilation is modulated by the Na,K-pump activity in rabbit coronary small arteries

The purpose of the study was to evaluate the importance of the Na,K-pump in relaxations induced by K(ATP)-channel openers in rabbit coronary small arteries. Arterial segments were mounted in myographs for recording of isometric tension. Whole-cell patch clamp was used to assess K(ATP)-channel currents in isolated smooth muscle cells from the arteries. In arteries preconstricted with the thromboxane A(2) analogue U46619 pinacidil and cromakalim induced concentration-dependent relaxations. In arteries preconstricted with potassium (124 mM) only high concentrations of pinacidil had a small relaxant effect. In arteries preconstricted with U46619 pinacidil-induced relaxations were unaffected by pretreatment with N(omega)-nitro-L-arginine (L-NNA) and only slightly reduced after mechanical removal of the endothelium. Pinacidil induced relaxations were not significantly affected by 1 microM glibenclamide. However, the relaxations were partly inhibited in potassium-free media and by 1 microM ouabain. In contrast, the concentration-dependent relaxation to cromakalim was partly blocked by 1 microM glibenclamide and partly by 1 microM ouabain and when both drugs were present the inhibition increased. Ouabain (1 microM) and glibenclamide (1 microM) each partly inhibited an ATP-sensitive current induced by pinacidil and cromakalim. In the presence of both inhibitors a greater inhibition was seen. When the solution in the patch pipette was sodium-free the current was reduced and ouabain had no effect. The study suggests that the relaxation to cromakalim and most likely pinacidil is mediated through opening of K(ATP) channels. Inhibition of the Na,K-pump, however, may change the local environment for the K(ATP) channels (i.e. increases the ATP/ADPratio and/or decreases the transmembrane potassium gradient), which partly prevents the activation of the K(ATP)-channel current.

Decreases in renal functional reserve and proximal tubular fluid output in conscious oophorectomized rats: normalization with sex hormone substitution

Age-dependent glomerulosclerosis with reduced GFR develops earlier among men than among women. Therefore, whether female sex hormones could prevent the age-dependent decrease in GFR was investigated. The kidney function in oophorectomized rats treated with placebo (OOX group), estrogen (OOX+E(2) group), or estrogen plus progesterone (OOX+E(2)+P group) for 5 mo and in sham-operated rats (sham group) was examined. The rats were 13 mo of age at the time of the investigation. They were conscious and chronically instrumented. The results demonstrated that estrogen, alone or in combination with progesterone, was without effect on the baseline GFR and effective renal plasma flow but prevented severe decreases in the renal functional reserve and fractional proximal tubular fluid output (lithium clearance technique, fractional lithium excretion), which were observed in the OOX group. The renal functional reserve (estimated by stimulation with glycine) was -223 +/- 151, 483 +/- 129, 675 +/- 76, and 208 +/- 140 micro l/min in the OOX, OOX+E(2), OOX+E(2)+P, and sham groups, respectively. Fractional lithium excretion was 12.4 +/- 3.1, 26.8 +/- 2.0, 31.8 +/- 2.5, and 23.6 +/- 3.3% in the OOX, OOX+E(2), OOX+E(2)+P, and sham groups, respectively. In conclusion, oophorectomy at the age of 8 mo did not produce a decrease in baseline GFR in female rats within a period of 5 mo. However, oophorectomy led to severe decreases in the renal functional reserve and fractional proximal tubular fluid output. Both effects were prevented with administration of estrogen. Sham-operated rats demonstrated values for renal functional reserve and fractional lithium excretion that were between those observed for the OOX group and the groups treated with sex hormones.

Transforming growth factor ?1-induced glomerulopathy is prevented by 17?-estradiol supplementation

Transforming growth factor beta1 (TGF-beta1) affects extracellular matrix (ECM) accumulation. It plays a role in the thickening of the peripheral basement membrane (PBM) and expansion of the mesangium in several renal diseases. The beneficial influence of female gender on the progression of chronic renal diseases may be explained by a favorable effect of estrogen on ECM homeostasis. Interactions between TGF-beta1 and estrogen have been investigated in mesangial cell cultures. However, it is unknown if TGF-beta1-induced glomerulopathy in vivo is influenced by exogenous estrogen. Thus, the aim of the present experiment was to explore whether estrogen prevents the development of TGF-beta1-induced glomerular disease in transgenic mice expressing active TGF-beta1 under control of the Ren-1c promoter. Mice were treated from 3 weeks to 6 weeks of age with 17beta-estradiol release pellets (5-10 microg/kg body weight per day). At the age of 6 weeks, all investigated animals were sacrificed for estimation of PBM thickness, the mesangium per glomerulus [Vv(mes/glom)], the mesangial matrix per glomerulus [Vv(matrix/glom)] and the PBM per glomerulus [Vv(PBM/glom)] using electron microscopy and stereological methods. Furthermore, the total collagen content was determined. We found that TGF-beta1-induced alterations in Vv(mes/glom), Vv(matrix/glom) and Vv(PBM/glom) were prevented in mice exposed to exogenous 17beta-estradiol. In addition, the interstitial fibrosis that develops in TGF-beta1 transgenic mice was attenuated by administration of 17beta-estradiol. In conclusion, estrogen may oppress TGF-beta1-mediated kidney diseases and, thereby, contribute to the protracted development of end-stage renal disease in pre-menopausal women.

The Influence of Amphotericin B and Neomycin on the Effect of Human Relaxin-2 on Foetal Membranes and Isolated Myometrium

In vitro studies have documented effects of relaxin on utero-placental tissues. Previously unpublished experiments indicate that neomycin and amphotericin B in vitro influences the effect of human relaxin-2 on the strength of human foetal membranes. The aim of the current study was to investigate the interaction between neomycin and amphotericin B and human relaxin-2 using human foetal membranes, human myometrium and rat myometrium. Chloramphenicol, erythromycin and penicillin were also examined. Human foetal membranes were stretched until rupture in a materials-testing machine while the contractility of rat and human myometrium were examined by myography. Human relaxin-2 (hrlx-2, 10(-9) M) induced a decreased strength in human foetal membranes, although this effect of hrlx-2 was inhibited after co-incubation with neomycin and amphotericin B. Hrlx-2 (10(-9) M) in combination with chloramphenicol induced a decreased strength of human foetal membranes. Hrlx-2 (10(-9) M) decreased myometrial contractility on amplitude and frequency in the rat myometrium, but had no effect on baseline tension. After exposure to amphotericin B, hrlx-2 induced a more pronounced decrease in amplitude, increased baseline tension and increased the frequency of contractions of the rat myometrium. Hrlx-2 (10(-9) M) had no effect on the human myometrium. However, after exposure to amphotericin B or neomycin+amphotericin B, hrlx-2 induced an increase in baseline tension and a decrease in amplitude. Amphotericin B and neomycin+amphotericin B increased the frequency of contractions and this effect was further enhanced by the addition of hrlx-2. We therefore conclude that amphotericin B and neomycin + amphotericin B may have an influence on relaxin's effect on isolated foetal membranes and myometrium.

Pulmonary endothelial dysfunction after cardiopulmonary bypass in neonatal pigs

BACKGROUND

In neonatal pigs cardiopulmonary bypass (CPB) is associated with endothelial dysfunction in isolated large pulmonary arteries. It is, however, of great importance if this functional change extends to the small pulmonary resistance arteries, which are the key regulators of pulmonary flow and pressure. The aim of this study was to assess changes in pulmonary microvascular function after CPB using a clinically relevant pediatric procedure.

METHODS

From three groups of neonatal pigs (CPB-, sham- and control group) pulmonary resistance arteries and systemic resistance arteries (from skeletal muscle) were isolated and mounted as ring preparations in wire myographs. Vessel diameters were less than 500 microm. Concentration-response curves were constructed for norepinephrine (NA), vasopressin (Vp), and the thromboxane A2-analog U46619, while the endothelium-dependent and -independent vasodilator functions were assessed as responses to acetylcholine and nitric oxide (NO).

RESULTS

Maximum pulmonary vasodilator response to acetylcholine was attenuated after CPB compared with sham-operated and control animals (P=0.04). NO-induced relaxation, and contractile responses to NA, Vp, and U46619 were not influenced by CPB. In systemic arteries no changes in contractile or relaxant responses were seen after CPB.

CONCLUSION

CPB seems to induce pulmonary endothelial dysfunction in pulmonary but not peripheral resistance arteries in neonatal piglets.