Electron microscopic changes of detrusor in benign enlargement of prostate and its clinical correlation

ABSTRACT Aims: To study the ultra structural changes in bladder musculature in cases of BPE and their clinical relevance. Material and Methods: In this descriptive longitudinal, controlled, observational study patients were enrolled into three groups, group 1, group 2A and group 2B. Control group (group-1) consisted of age matched normal male patients, who underwent surveillance or diagnostic cystoscopy for microscopic hematuria or irritative symptoms. Case group (group-2) comprised of patients with BPE, undergoing TURP. Case group (group-2) was further classified into: Category 2A (patients not on catheter) and category 2B (patients on catheter). All relevant clinical parameters like IPSS, prostate size, Qmax, PVR were recorded. Cystoscopy and bladder biopsy were performed in all patients. Various ultrastructural parameters like myocytes, fascicular pattern, interstitial tissue, nerve hypertrophy and cell junction pattern were analyzed under electron microscope and they were clinically correlated using appropriate statistical tests. Results: Control group had significant difference as compared to case group in terms of baseline parameters like IPSS, flow rate and prostate size, both preoperatively and postoperatively, except for PVR, which was seen only preoperatively. There was statistically significant difference in ultrastructural patterns between case and control group in all five electron microscopic patterns. However, no significant difference was found between the subcategories of case groups. Conclusions: BPE is responsible for ultra structural changes in detrusor muscle and these changes remain persistent even after TURP. Nerve hypertrophy, which was not thoroughly discussed in previous studies, is also one of the salient feature of this study.

Penile alterations at early stage of type 1 diabetes in rats

ABSTRACT Objective Diabetes affects the erectile function significantly. However, the penile alterations in the early stage of diabetes in experimental animal models have not been well studied. We examined the changes of the penis and its main erectile components in diabetic rats. Materials and methods Male Sprague-Dawley rats were divided into 2 groups: streptozotocin (STZ)-induced diabetics and age-matched controls. Three or nine weeks after diabetes induction, the penis was removed for immunohistochemical staining of smooth muscle and neuronal nitric oxide synthase (nNOS) in midshaft penile tissues. The cross-sectional areas of the whole midshaft penis and the corpora cavernosa were quantified. The smooth muscle in the corpora cavernosa and nNOS in the dorsal nerves were quantified. Results The weight, but not the length, of the penis was lower in diabetics. The cross-sectional areas of the total midshaft penis and the corpora cavernosa were lower in diabetic rats compared with controls 9 weeks, but not 3 weeks after diabetes induction. The cross-sectional area of smooth muscle in the corpora cavernosa as percentage of the overall area of the corpora cavernosa was lower in diabetic rats than in controls 9 weeks, but not 3 weeks after diabetes induction. Percentage change of nNOS in dorsal nerves was similar at 3 weeks, and has a decreased trend at 9 weeks in diabetic rats compared with controls. Conclusions Diabetes causes temporal alterations in the penis, and the significant changes in STZ rat model begin 3-9 weeks after induction. Further studies on the reversibility of the observed changes are warranted.

Is a secondary procedure necessary in every case of failed endoscopic treatment for vesicoureteral reflux?

PURPOSE: Endoscopic treatment (ET) has become a widely accepted procedure for treating vesicoureteral reflux (VUR). However, patients followed up after ET over long periods have reported persistent or recurrent VUR. We evaluated the natural course of failed ET in patients who required further treatments to help physicians in making decisions on the treatment of VUR. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who were diagnosed with VUR and underwent ET from January 2006 to December 2009. A total of 165 patients with 260 ureters underwent ET. We compared the parameters of the patients according to ET success or failure and evaluated the natural course of the patients after ET failure. RESULTS: Mean VUR grade and positive photon defect were higher in the failed ET group than in the successful ET group. Six months after the operation, persistent or recurrent VUR was observed in 76 ureters (29.2%), and by 16.3 months after the operation, VUR resolution was observed in 18 ureters (23.7%). Twenty-five ureters (32.9%) without complications were observed conservatively. Involuntary detrusor contraction was found in 1 of 9 (11.1%) among the secondary ET success group, whereas in the secondary ET failure group, 4 of 6 (66.7%) had accompanying involuntary detrusor contraction. CONCLUSIONS: Patients in whom ET fails can be observed for spontaneous resolution of VUR unless they have febrile urinary tract infection or decreased renal function. Urodynamic study may be helpful in deciding whether a secondary procedure after ET failure is necessary.

Urethral dysfunction due to alloxan-induced diabetes. Urodynamic and morphological evaluation

PURPOSE: To evaluate the effect of short and long term alloxan-induced diabetes on bladder and urethral function of female rats, and also describing its correlated morphological alterations. METHODS: Thirty five female rats were divided into three groups: G1 (n=9), control group; G2 (n=17), six weeks alloxan-induced diabetic rats; G3 (n=9), 20 weeks alloxan-induced diabetic rats. Functional evaluation was performed by cystometry and simultaneous measurements of the urethral pressure during bladder filling and voiding. Morphological evaluation was also performed with measurement of bladder and urethral fibrosis and collagen content and thickness of lamina propria and smooth muscle layers. RESULTS: The peak bladder pressures and contraction amplitudes were decreased in 100% and 47% of the G3 and G2 groups respectively, when compared to control. Bladder overactivity was observed in 53% of the G2 group. CONCLUSION: Alloxan-induced diabetes urethropathty in female rat was associated to bladder morphological alterations as higher thicknesses of it lamina propria, detrusor and adventicea. .

Qual o índice de massa corporal de mulheres com disfunções dos músculos do assoalho pélvico que procuram tratamento fisioterapêutico? / What is the body mass index of women with pelvic floor muscles dysfunctions that seek for physiotherapy treatment?

Sobrepeso e obesidade são relatados como importantes fatores de risco para desenvolvimento de disfunções do assoalho pélvico (AP) feminino. Assim, objetivou-se averiguar o índice de massa corporal (IMC) de mulheres com disfunções do AP que procuraram tratamento fisioterapêutico, e comparar com as estatísticas nacionais. Trata-se de um estudo observacional. Foram avaliados os prontuários de mulheres com disfunções do AP atendidas pelo Setor de Fisioterapia no período de 2004 à 2010, e incluídas todas as mulheres com a presença de algum sintoma de disfunção do AP. Calculou-se o IMC de 312 mulheres com disfunção do AP. A média de IMC foi de 28,1 kg/m2. Dessas mulheres, cerca de 70% apresentavam sobrepeso ou obesidade, resultado maior do que o índice nacional de 59%. A base fisiopatológica da relação entre obesidade e disfunções do AP está na correlação entre o IMC e a pressão intra-abdominal. A identificação do sobrepeso e da obesidade deve fazer parte dos programas de reabilitação do AP, uma vez que a redução do peso corporal pode contribuir para redução da severidade da disfunção. Com o presente estudo observa-se que as mulheres que procuram tratamento fisioterapêutico para disfunções do AP apresentam índice de obesidade maior do que a população feminina nacional.

Overweight and obesity are reported as important risk factors for developing of female pelvic floor (PF) dysfunction. Thus, the objective was to verify the body mass index (BMI) of women with PF dysfunctions who sought physiotherapy treatment, and comparing it with national statistics. This is an observational study. There were evaluated the records of women with PF dysfunctions served by the Physiotherapy Service from 2004 to 2010, and included all women with the presence of any symptom of PF dysfunction. It was calculated the BMI of 312 women with PF dysfunction. The BMI mean was 28.1 kg/m2. Approximately 70% of these women were overweight or obese, a value higher than the national rate of 59%. The pathophysiological basis of the relationship between obesity and PF dysfunction is the correlation between BMI and intra-abdominal pressure. The identification of overweight and obesity should be part of the rehabilitation programs of the PF, since the reduction in body weight can contribute by reducing the severity of the disorder. With the present study it was observed that women seeking physiotherapy treatment for PF dysfunction have higher rates of obesity than the national female population.

Disfunções de assoalho pélvico em atletas / Pelvic floor dysfunction in athletes

Disfunções do assoalho pélvico são condições que acometem mulheres em idades variadas, porém aquelas que se encontram no período do climatério, assim como as multíparas, são as mais suscetíveis. Entretanto, há relatos na literatura de jovens nulíparas que apresentam sintomas de disfunções nesta região, tais como a incontinência urinária e a anal durante a prática de esportes. Essas condições podem levar ao abandono da atividade física e comprometer a qualidade de vida. Com o intuito de conhecer a ocorrência das disfunções do assoalho pélvico e seus fatores etiológicos em atletas jovens e nulíparas, foi feita uma revisão da literatura. Foram consultadas as bases de dados BVS e PubMed nos últimos dez anos. Os resultados dos estudos revisados indicaram alta prevalência de disfunções do assoalho pélvico entre atletas, muitas delas nulíparas. A incontinência urinária é a disfunção do assoalho pélvico mais documentada e acomete principalmente atletas que praticam atividades consideradas de alto impacto, como trampolim e paraquedismo. As condições que desencadeiam as disfunções do assoalho pélvico em mulheres jovens e nulíparas ainda não estão completamente elucidadas, alterações extrínsecas ou genéticas do tecido conjuntivo frouxo e atividades que envolvem longos saltos são as hipóteses mais frequentes. Apenas um estudo foi encontrado documentando a prevalência das disfunções do assoalho pélvico entre atletas envolvendo os sistemas intestinal e sexual, além do urinário

Pelvic floor dysfunctions are conditions that affect women in various ages, however those in the climacteric period, as well as the multiparous are more susceptible to it. However, there are studies in the scientific literature reporting the occurrence of urinary incontinence during sports among young and nuliparous women. Such conditions can lead to a withdrawn from physical activity compromising the quality of life. A literature review in PubMed and in VHL databases, within the last ten years, was done in order to understand the occurrence of symptoms suggestive of pelvic floor dysfunctions other than urinary incontinence, such as anorectal or sexual dysfunction, and their etiological factors in young and nulliparous athletes. Results indicated a high prevalence of urinary incontinence among athletes, who were engaged in high-impact activities such as trampoline, and skydiving. The conditions that contribute to the urinary incontinence etiology in young and nulliparous women are still not fully understood, extrinsic or genetic changes in loose connective tissue and activities involving long jumps are the most common hypotheses to this condition. Other than urinary tract symptoms, it was found only one study documenting pelvic floor disorders involving the intestinal and sexual systems in such population

Alterações do tecido conjuntivo e músculo liso no pênis de coelhos diabéticos / Connective tissue and smooth muscle alterations in diabetic rabbit penis

Introdução: Embora a disfunção erétil seja um problema frequente em pacientes com diabete mellitus, poucos estudos avaliaram as alterações da estrutura peniana nesta condição. Objetivo: Avaliar a densidade volumétrica de colágeno, fibras do sistema elástico e células musculares lisas no corpo cavernoso (CC), corpo esponjoso (CE) e túnica albugínea (TA) no pênis de coelhos diabéticos. Método: Vinte seis coelhos Nova Zelândia foram utilizados. A diabete foi induzida em 13 coelhos com 8 semanas de idade com injeção intravenosa de 100 mg/kg de aloxano. 13 colehos normais serviram como controle. Após 10 semanas os animais foram mortos com overdose de thiopenthal sódico endovenoso. Os pênis foram dissecados retirando-se um fragmento da porção média sendo fixado em formol 10% tamponado (pH 7.3). Todo material foi processado para inclusão em parafina seguindo a técnica histológica de rotina. Principais medidas: A análise estereológica do colágeno, das fibras do sistema elástico e do músculo liso foi realizada em cortes de 5um no sistema teste M42. Os dados foram expressos em densidade volumétrica (Vv %). A organização de colágeno foi avaliada pela coloração do Picrosirius red sob polarização. Resultados: na túnica albugínea de coelhos diabéticos, houve um aumento de 88% da espessura (p<0.0003) com um acentuado turnover do colágeno. Além disso, o conteúdo de fibras elásticas foi 34% maior (p<0.0001). No CC dos coelhos diabéticos o colágeno diminuiu 45% (p<0.0001) com a presença de um colágeno mais organizado. As fibras do sistema elástico tiveram um decréscimo de 46% (p<0.0001). A diabete induziu um aumento de 11% de colágeno no CE (P<0.0235) com um acentuado turnover do colágeno. No CC de coelhos diabéticos houve um aumento de 40% de músculo liso (p<0.0001), enquanto no CE uma diminuição de 38% (p<0.0001). Conclusão: Os tecidos do pênis foram afetados de formas diferentes pela diabete, possivelmente devido à heterogeneidade celular...

Introdution: Although erectile dysfunction is a frequent problem in patients with diabetes mellitus, few studies have evaluated penile structure alteration in this condition. Aim: To assess the volumetric density of collagen, elastic system fibers and smooth muscles cells in the corpora cavernosa (CC), corpus spongiosum (CE) and tunica albuginea (TA) in the penis of diabetic rabbits. Methods: Twenty-six New Zealand white rabbits were used. Diabetes was induced at 8 weeks of age in 13 rabbits by intravenous injection of 100 mg/kg of alloxan. The remaining 13 rabbits served as a control group. After 10 weeks, the rabbits were killed using sodium thiopenthal. Mid-shaft fragments of the penis were obtained and processed by routine histological techniques. Main Outcome Measures: Stereological analysis of collagen, elastic system fibers and smooth muscle was performed in 5-um sections by using a M42 System Test grid. Data were expressed as volumetric density (Vv - %). Collagen organization was evaluated by Picrosirius red staining under polarization. Results: In the TA of diabetic rabbits, thickness increased by 88% (p<0.0003) with an enhanced collagen turnover. Moreover, the elastic fiber content was 34% higher (p<0.0001). In the CC of diabetics, collagen was diminished by 45% (p<0.0001) with a more organized collagen. The elastic fibers were decreased by 46% (p<0.0001). Diabetes induced a 11% increase in CS collagen (p<0.0235) with an enhanced collagen turnover. Smooth muscle in the CC of diabetic rabbits was increased by 40% (p<0.0001), whereas in the CS it was decreased by a similar amount (p<0.0001). Conclusion: Penile tissues were affected differently by diabetes, possibly due to cellular heterogeneity. These changes could have an impact on blood flow and tissue resistance, and therefore, might adversely affect erection...

Long term evaluation of functional and morphological bladder alterations on alloxan-induced diabetes and aging: experimental study in rats / Avaliação funcional e morfológica tardia de alterações na bexiga secundárias ao diabetes induzido por aloxano e no envelhecimento: estudo experimental em ratos

PURPOSE: to evaluate structural and functional effects of Alloxan- induced diabetes and aging on bladder of rats. METHODS: evaluations were performed in three groups: A - 8 weeks of age, B - 44 weeks of age, C - 44 weeks of age with alloxan-induced diabetes. Muscle layer thickness, extracellular matrix fibrosis and collagen were quantified on digital images of bladder samples. Cystometric evaluations before surgical vesical denervation (SVD), included maximum cystometric capacity (MCC), maximum bladder pressure (MBP), bladder contraction frequency (VCF), duration of bladder contraction (DC), threshold pressure (TP) and bladder compliance (BC). After SVD, maximum cystometric capacity (MCC), BC and maximum urethral closing pressure (MUCP) were also measured. RESULTS: Reduced extracellular matrix fibrosis concentration and contraction strength were found in the bladders of group C. Before SVD, bladder compliance was not different between groups. Alterations were observed in MCC after SVD. CONCLUSIONS: We did not notice smooth muscle hypertrophy in Alloxan-induced diabetic rats after 44 weeks. There was alteration in the total and relative amount of fibrosis and collagen. The cystometric studies support the idea that this morphological alterations are important to determine the different bladder functional patterns found in the aging and the Alloxan-induced diabetic animals.

OBJETIVOS: avaliar alterações estruturais e funcionais da bexiga de ratos machos, associadas ao diabetes induzido por aloxano e ao envelhecimento. MÉTODOS: três grupos de animais: A - 8 semanas de idade; B- 44 semanas de idade; C - 44 semanas de idade com diabetes induzido por aloxano, foram avaliados. Realizadas medidas de espessura da camada muscular, fibrose de matriz extracelular e quantidade de colágeno, através de análise de imagem digital dos tecidos. Realizados também testes cistométricos, antes da desnervação vesical cirúrgica (DVC), para avaliar capacidade vesical (CV), intensidade máxima de contração vesical (IMCV) e complacência vesical. Após a DVC, foram avaliadas capacidade vesical após a desnervação (CVAD), complacência vesical (CV) e pressão de perda uretral (PPU). RESULTADOS: não foi observada hipertrofia da camada muscular nas bexigas; houve diminuição da concentração de fibrose da matriz extracelular e diminuição da força contrátil, e aumento da capacidade vesical no grupo C. CONCLUSÕES: a atrofia da camadas muscular da bexiga esta relacionada ao diabetes induzido por aloxano. O envelhecimento, como fenômeno isolado, provoca alterações nos parâmetros funcionais, porém associado ao diabetes, gera alterações na IMCV, CV e CVAD. Existe correlação entre alterações estruturais e funcionais nos animais diabéticos após a desnervação.

Stereological study of collagen and elastic system in the detrusor muscle of bladders from controls and patients with infravesical obstruction

OBJECTIVE: Compare detrusor muscle of normal and patients with infravesical obstruction, quantifying the collagen and elastic system fibers. MATERIALS AND METHODS: We studied samples taken from bladders of 10 patients whose ages ranged from 45 to 75 years (mean = 60 years), who underwent transvesical prostatectomy for treatment of BPH. Control material was composed of 10 vesical specimens, removed during autopsies performed in cadavers of accident victims, with ages between 18 and 35 years (mean = 26 years). RESULTS: The results of collagen and elastic fibers quantification (volumetric density) demonstrated the following results in percentage (mean +/- standard deviation): collagen in BPH patients = 4.89 +/- 2.64 and 2.32 +/- 1.25 in controls (p < 0.0001), elastin in BPH patients = 10.63 percent +/- 2.00 and 8.94 percent +/- 1.19 in controls (p < 0.0001). CONCLUSION: We found that the components of connective tissue, collagen and elastic system fibers are increased in the detrusor muscle of patients with infravesical obstruction, when compared to controls.

Assessment of urodynamic bladder behavior on filling with solutions representing physiological extremes of urinary osmolarity

OBJECTIVE: Verify if there is any difference in sensitive and motor bladder response in the presence of solutions with different osmolarities, simulating physiological extremes of urinary osmolarity. MATERIALS AND METHODS: Thirty-three patients (24 men and 9 women) with mean age of 46.4 years (8 to 87 years) took part in this study. They were all subjected to 2 consecutive urodynamic examinations. In each exam, the vesical filling was accomplished by using a hyperosmolar (1000 mOsm/L) or hypo-osmolar (100 mOsm/L) sodium chloride solution in similar speed. The sequence in which each solution was instilled was determined by a double blind draw. The urodynamic results obtained from the infusion of both solutions were compared, regardless the sequence of administration. RESULTS: Fifteen patients (45.4 percent) showed detrusor hyperactivity, 12 of whom with neurological antecedents. The mean age of those with detrusor hyperactivity was 45.8 years, against 46.9 for those without hyperactivity. The infusion of the hyperosmolar/hypo-osmolar solution generated the following results, when comparing patients without vs. with detrusor hyperactivity: initial sensation of vesical filling (mL): 167.5 / 159.2 vs. 134.9 / 157.3 (p > 0.05); volume of occurrence of the first involuntary bladder contraction (mL): 163.9 / 151.9 (p > 0.05); detrusor micturition pressure (cm H2O): 24.0 / 24.4 vs. 13.8 / 27.5 (p > 0.05). CONCLUSION: The vesical filling with solutions simulating extreme urinary osmolarities, accomplished with similar speed and without previous identification, did not likewise alter the sensitive and motor urodynamic behavior in the current study.

Structural alterations of the bladder induced by detrusor instability: experimental study in rabbits

OBJECTIVES: The aim of this study was to evaluate the histopathological and immunohistochemical alterations induced by detrusor instability in the bladder of rabbits submitted to partial bladder outlet obstruction. MATERIALS AND METHODS: Thirty male Norfolk rabbits were divided into 2 groups, a clinical control and a group with detrusor instability. Urine culture, cystometric study, histopathological and immunohistochemical analysis were performed in all animals prior to surgery (M1) and 4 weeks after-surgery (M2). RESULTS: Partial obstruction (G2) resulted in a 2.5 fold increment (p < 0.05) in bladder weight when compared to control (G1). Four weeks after surgery, 93 percent of animals in G2 developed cystitis. Partial obstruction resulted in detrusor instability at M2 and bladder capacity was significantly increased (p < 0.05) from M1 to M2. The incidence of mild to moderate mucosal and adventitious fibrosis at M2 was higher in G2 (p < 0.05) when compared to G1. Inflammatory reaction at M2 was statistically higher (p < 0.05) in G2. There was no difference in muscular hypertrophy between M1 and M2 in G1. However, 67 percent of G2 bladders showed a moderate to intense muscular hypertrophy at M2. Hyperplasia of the epithelium was also increased in G2 when M1 and M2 were compared (p < 0.05). CONCLUSION: Detrusor instability induced by partial bladder outlet obstruction caused significant histopathological and immunohistochemical alterations in the bladder of rabbits.

Computerized morphometric analysis of muscular structure in pelviureteric junction obstruction [PUJO] based on aetiology and duration of obstruction

The pathophysiology of pelviureteric junction obstruction [PUJO] is unknown. Abnormalities of smooth muscle and/or collagen fibers in PUJ were reported by light and electron microscopes. Computerized image analysis was used to objectively quantify the percentage of smooth muscle fibers in surgical specimens of PUJ obtained from 45 patients [28 male and 17 female], aged 1- 53 years mean age 27.48 +/- 12.27, after surgical repair using dismembered technique of pyeloplasty. Control materials were obtained from 10 patients [aged 40-70 years] in whom nephrectomy was done for other pathology than PUJO. Twenty different fields were examined for each tissue section, which were stained by Masson trichrome stain for smooth muscle fibers. In patients with PUJO the percentage of smooth Muscle fibers [SMFs] ranged between 16 and 44% with a mean 26.08 +/- 5.68 while in control group, the Percentage of SMFs was ranging between 41 and 89%with amean 64.22 +/- 13.13 In 34 patients with intrinsic PUJO the percentage of SMFs ranged from 15 to 49% with a mean 24.71 +/- 4.74 while in 11 patients with extrinsic PUJO it ranged between 15 and 49% with a mean 30.31 +/- 6.47. Out of 34 patients with intrinsic PUJO, in patients below I6 years [n=10] the percentage of SMF ranged between 17 and 44% with a mean 27.83 +/- 4.3 and while in patients above 16 years [n=24] the percentage of SMF ranged between 15 and 49% with a mean 23.41 +/- 4.33. The significant difference between mean percentage of smooth muscle fibers in PUJO group 26.08% and control group 64.22% indicate the role of SMF in pathogenesis of PUJO. The difference between percentage of SMF in intrinsic PUJO 24.71% and those of extrinsic causes 30.3 1%, confirm this finding. The difference in percentage of SMFs in patients with intrinsic PUJO below 16 years 27.83% and those above 16 years 23.41% indicate that the duration of obstruction may affect the muscular structure

Histopatologia do saco herniário das hérnias inguinais: a importância do conhecimento morfológico sacular / Hernial sac histophatology of inguinal hernia: the saccular morphological knowledge

O conteúdo do saco herniário sempre foi motivo de preocupaçäo por parte do cirurgiäo, embora a estrutura de sua parede seja ainda pouco estudada e conhecida. O objetivo do trabalho é avaliar a influência de sexo, cor, idade, regiäo do saco herniário, lado da hérnia, largura, comprimento e espessura da amostra peritoneal na presença de fibras musculares lisas (FML) na parede do saco herniário inguinal. Pretende-se também descrever a histologia dos sacos herniários e apresentar algumas teorias sobre a origem das FML, além de destacar a importância do conhecimento da estrutura sacular na identificaçäo de condiçöes patológicas encobertas e certificar o uso do próprio saco como instrumento de reforço nas correçöes cirúrgicas. Amostras de 252 sacos herniários obtidos no tratamento operatório de hérnias inguinais indiretas, diretas, recidivadas e encarceradas foram encaminhadas para o estudo histopatológico, e foram coradas por Hematoxilina-Eosina (HE) e tricrômico de Gomori para a identificaçäo de FML. Estas estiveram presentes em 67,9 por cento das amostras, e ocorreram de modo significativo nas hérnias indiretas e recidivadas, quando comparadas com as diretas e encarceradas. Em relaçäo às variáveis estudadas, os pacientes que apresentaram FML näo diferiram significativamente daqueles em que as mesmas näo foram observadas. Quando presentes, as FML muitas vezes estavam associadas com vasos sangüíneos espessos, sugerindo a origem à partir da camada média do vaso e podem representar um reforço tecidual em resposta ao trauma mecânico ou a outros fatores da patogênese da hérnia. Foi observado também que o saco herniário pode sediar vários processos patológicos que atingem o peritônio parietal, como a endometriose, inflamaçöes específicas e processos hiperplásicos ou mesmo neoplásicos, inclusive podendo constituir, em alguns casos, a primeira evidência de neoplasias.

Esophageal motility disorders in Mexican patioents with Duchenne's muscular dystrophy

Objetive: Myopathies are entities tahat mainly involve strieted muscle. In Duchenne's muscular dystrophy (DMD) there have been reported smooth muscle alterations in the pre-oral phase of swallowing, in gastric emptying, and pseudoobstruction. Nevertheless, esophageal motility alterations are not concluding. The objetive of this work was to determine if there are motor esophageal alterations is this patients, and if this alterations are related to the clinical manifestations of disease. Study design: nine consecutive patients with DMD (mean age 8, range 6-11 years; males) were evaluated, comparing clinical and manometric findings. Results: esophageal manometry alterations were found in all patients, mainly simultaneous non-peristaltic waves (60.86 percent) of diminished amplitude, in both striated and smooth muscle. Seventy seven percent presented with upper and lower gastrointestinal symptoms (dysphagia, regurgitation, epigastric pain, constipation, and distention). No correlation was found between esophageal motility alterations and gastrointestinal symptoms, nor with the clinical stage of disease in accordance to Brook (r=0.27). Conclusion: these results show that patients with DMD present esophageal motor disorders in both striated and smooth muscle, as well as upper and lower gastrointestinal symptoms. Specialized motility studies, could yield a better understanding of disease, and, possibly with adequate treatment, provide for a better quality of life in children with DMD.

Anaphylactic reaction in smooth muscle from the duck

1. Para saber si la falta de desensibilizacón en el pollo es característica del tejido aviario, se estudió la reacción anafiláctica en el pato. Las contracciones provocadas en segmentos de intestino de patos sensibilizados activamente, por exposición al antígeno específico, o reacción de Schultz-Dale, se comparan con respuestas similares de intestino sensibilizado de pollo y de cobayo. 2. El músculo liso de pollo sensibilizado activamente, se contrae cuando se le expone in vitro al antígeno específico. La tensión máxima desarrolalada duratne la reacción anafiláctica, se mantiene hasta que se lava la preparación. Una nueva exposición del músculo al antígeno produce otra vez desarrollo de tensión. Esto significa que la exposición al antígeno no desensibiliza el intestino de pollo. 3. El músculo liso intestinal de patos sensibilizados desarrolló tensión cuando se añadió el antígeno específico al bño, la tensión fué transitoria y pronto alcanzó la línea basal aún antes de lavar el antígeno. A diferencia de las observaciones en el músculo liso del pollo, una segunda dosis de antígeno no produce contracciónd el intestino del pato. El músculo liso del pato se comportó como el tejido del mamífero. La exposición al antígeno desensibilizó el intestino del pato. 4. En el pato con sensibilización múltiple, el orden de administración de los antígenos y su desensibilización no modifican la respuesta anafiláctica a cada antígeno. 5. Estos resultados se discuten en términos de las propiedades conocidas de los anticuerpos del pato

Changes in the contractile activity of the male genital tract as a consequence of vasectomy

La actividad contráctil de la cola del epidídimo y el conducto deferente de la rata fue registrada mediante una cámara de video, a varios intervalos hasta 180 días después de la vasectomía. Ya a las 24 horas de la operación pudo registrarse una actividad rítmica peristáltica, especialmente en la porción distal de la cola del epidídimo. Las concentracciones aumentaron progresivamente durante los 30 días subsiquientes a las vasectomías. Luego la actividad permaneció estabilizada hasta los 180 días de la operación. Las contracciones fueron más frecuentes en los tractos genitales sin granulomas que en los que presentaron esta complicación. Cuando el conducto exhibió una gran distensión sus paredes musculares no mostraron ningún tipo de contractilidad, la cual no reapareció aun cuando una incisión parcial en el conducto deferente fue efectuada con el objetivo de disminuir la dilatación del tubo. Desde que un transporte espermático normal parece se necesario para que se produzca la maduración completa de los espermatozoides, es posible que la persistencia de la infertilidad que se observa en los pacientes vasovasostomizados pueda estar vinculada con la pérdida de una adecuada actividad por parte de los conductos como consecuencia de la vasectomía