Detrusor myectomy for detrusor overactivity: a minimum 1-year follow-up.

OBJECTIVE: To evaluate the clinical and urodynamic outcome of partial detrusor myectomy in patients with idiopathic detrusor instability and neuropathic hyper-reflexia. PATIENTS AND METHODS: Seventeen patients with idiopathic detrusor instability and 10 with hyper-reflexia and symptoms not responding to non-surgical treatment underwent partial detrusor myectomy. The clinical and urodynamic results before and after myectomy were compared and the patient's subjective assessment of the outcome documented. RESULTS: There was an overall improvement in 17 of 27 patients (63%) but the success rate was higher in those with idiopathic instability (12 of 17) than in those with neuropathy (five of 10). There was urodynamic evidence of reduced bladder contractility and an improvement in the storage characteristics of the bladder in most of the patients treated. CONCLUSIONS: Partial detrusor myectomy is relatively simple and is associated with minimum morbidity and an acceptable success rate. The procedure alters the urodynamic behaviour of the bladder and leads to symptomatic and objective improvement, giving better results with idiopathic than with neuropathic detrusor overactivity. Detrusor myectomy may be offered to patients with detrusor overactivity unresponsive to conventional management. The option of enterocystoplasty is still open to patients with an unsuccessful outcome. However, the long-term results and surgical variations of the technique should be evaluated further.

Desmopressin in the treatment of nocturia and enuresis in patients with multiple sclerosis.

OBJECTIVES: To assess whether the synthetic vasopressin analogue desmopressin [1-desamino 8-D-arginine vasopressin] is efficacious and safe in the management of nocturia +/- enuresis in patients with multiple sclerosis. PATIENTS AND METHODS: Twenty-two women and 11 men, under 65 years of age, with clinically definite multiple sclerosis and nocturnal frequency +/- enuresis were entered into the study. A two week placebo run-in, to establish normal voiding patterns, followed by a double-blind, placebo-controlled, cross-over study of 20 micrograms intranasal desmopressin at night-time was carried out. RESULTS: Desmopressin caused a significant decrease in nocturnal urinary frequency, nocturnal urinary volume and the percentage of total daily urine passed at night. There was no significant fall in plasma sodium with desmopressin although there were two cases of asymptomatic hyponatraemia. CONCLUSION: Desmopressin is an efficacious and safe treatment for nocturia +/- enuresis in patients with multiple sclerosis.

Testicular denervation. A new surgical procedure for intractable testicular pain.

Chronic testicular pain has many different aetiologies. Identification and treatment of an underlying problem resolve the issue in most cases. However, a proportion of patients with chronic testicular pain have no demonstrable aetiological factor and pose a difficult treatment problem. All of these patients are initially treated by non-surgical measures. Various operations advocated in the literature for non-responders include epididymectomy, scrotal orchiectomy and inguinal orchiectomy, all of which have a significant failure rate. We describe a hitherto unreported operative procedure in a series of 4 patients, with immediate and lasting relief of their pain.

Artificial urinary sphincters.

The use of artificial sphincters for the treatment of urinary incontinence has evolved steadily over the last few decades. Currently available designs are suitable for implantation in male and female patients of all age-groups. This article describes the clinical implications of artificial urinary sphincters in the treatment of incontinent patients.

Glycogen utilization in tissues of toad, Bufo melanostictus under electropolarity treatment.

Electropolarity treatment (0.8V/DC/Cm) was given to the gastrocnemius muscle of B. melanostictus every day for 5 min for 5 days. The glycogen content and aldolase activity levels increased and phosphorylase 'a' activity levels decreased on cathode treatment in muscle, liver and brain while an opposed trend was observed on anode treatment. The heart showed contrasting pattern under both cathode and anode electropolarity treatments.

Acute and chronic effects of insulin on lactate dehydrogenase (LDH) activity in tissues of albino rat (Wistar strain).

Male albino rats were treated with insulin for one week (acute) and four weeks (chronic). The lactate dehydrogenase (LDH) activity, lactate and pyruvate levels were estimated in the tissues of experimental and control animals. LDH activity decreased in all the tissues of acute- and chronic treated animals whereas the lactate content is elevated. Pyruvate content also showed increment except in heart and pancreas with reference to acute treatment where it is decreased. The hyperinsulinaemia effect in relation to lacticacidaemia and its influence on energy demand and ammonia secretion is discussed.

Effect of dieldrin on catalytic potential of field mouse Mus booduga brain acetylcholinesterase.

Substrate kinetics of acetylcholinesterase (AChE) were investigated in control and dieldrin-treated Mus booduga brains. Non competitive inhibition with respect to activation by acetylcholine was indicated by decreased maximal velocity (V) without change in Michaelis-Menten constant (Km). Activation energies (delta E) were found to be increased suggesting decreased efficiency of enzyme in dieldrin-treated mouse brains. Fall in the activity potential of AChE may account for the interference of dieldrin or its metabolites with the acetylcholine (ACh)--AChE system and deserve consideration in contributing to the neurotoxicity.

Skeletal muscle protein metabolism under denervation atrophy in dog, Canis domesticus.

Denervated dog gastrocnemius muscle has shown a progressive decrease in total protein content, alanine aminotransferase (AIAT), aspartate aminotransferase (AAT) and glutamate dehydrogenase (GDH) activity levels and elevation in free amino acid, ammonia, urea, glutamine contents and AMP deaminase activity levels during post-neurectemic days. The possible implications of these findings are discussed in relation to denervation atrophy.

Kinetics of succinic dehydrogenase inhibition by methyl parathion and its recovery by oximes and L-cysteine in hepatopancreas of Lamellidens marginalis.

Effects in vitro of methyl parathion on some kinetic constants of succinic dehydrogenase (SDH) in hepatopancreas of freshwater mussel, L. marginalis were studied. Altered pH vs. specific activity curves for SDH demonstrated significant inhibition by methyl parathion in buffered acidic, neutral and alkaline ranges. At high pH ranges IC50 (12.5 microM) of methyl parathion did not cause 50% inhibition enzyme as it did at neutral and acidic pHs. Activation energies (delta E) were found to be increased suggesting decreased efficiency of enzyme in presence of methyl parathion. Non-competitive inhibition with respect to activation by succinate was indicated by decreased maximal velocity (V) without change in Michaelis Menten constant (Km). Pyridine-2-aldoxime (25 microM), pyridine-4-aldoxime (15 microM) and L-cysteine (40 microM) neutralized the inhibition of SDH by methyl parathion (12.5 microM). The kinetic data suggests that inhibition of SDH by methyl parathion was pH and temperature independent.

Changes in respiration and ionic content in tissues of freshwater mussel exposed to methyl parathion toxicity.

Oxygen consumption and sodium, potassium and calcium concentration were determined in the freshwater mussel, Lamellidens marginalis, and its tissues during methyl parathion (MP) toxicity. A transient increase followed by decrease in whole animal or tissue respiration as a function of time was observed. Greater loss of calcium by the mantle, sodium by the gill, and calcium and sodium by the hepatopancreas and foot was observed. As compared to calcium and sodium, the loss of potassium by the tissues was less.

Transamination and glutamate deamination in Rana hexadactyla during induced ammonia toxicity.

Glutamate dehydrogenase (GDH) and the transaminases namely aspartate aminotransferase (AAT) and alanine aminotransferase (AIAT) were estimated in the muscle, liver, kidney, and brain of control and ammonium acetate administered frogs. The results indicated tissue specific responses during induced ammonotoxemia. The inherent endogenous ammonia production decreased in all the tissues. 2-Keto glutarate production appears to be the other main adaptive feature as a result of slightly stepped up transdeamination patterns.

A biphasic compartmentation of neuro-transmission associated metabolic patterns during electro-induced axoplasmic transport in sheep medulla oblongata.

In the sheep medulla oblongata, on the induction of polarity by the applied voltage gradient of direct current along the length, the enzymes such as acetylcholinesterase and glutamate dehydrogenase showed anodal transport while the enzyme arginase showed cathodal transport indicating the possession of negative and positive charge densities on the enzymes. These studies indicated that the glutamate bound metabolism, one towards ammonia formation and the other towards the energy production and neural transmission, have opposed electro-characteristics. The acetylcholinesterase system had anodal characteristics coupled to the glutamate dehydrogenase patterns. The existence of two charge based compartmentation is envisaged in the neural tissue.

Induced transient hyperammonemia in Rana hexadactyla with reference to the ammonia and urea excretion.

Different ammonia toxicity induced by ammonium acetate administration in frogs lead to variable excretion of ammonia and urea into the medium. When 11.45 mM/kg body weight of ammonium acetate was administered, ammonia excretion increased while urea excretion decreased. When 4.17 mM/kg body weight of ammonium acetate is administered, the urea excretion increased while ammonia excretion decreased. The possible metabolic conversion of ammonia and urea by the animal at high and low ammonium acetate administration has been discussed.