Complete Emptying Research Articles

Direction of Blood Flow in a Vein

Determining the direction of blood flow in the veins of the anterior abdominal wall is important because it differentiates cirrhosis from vena caval obstruction. In patients with dilated abdominal wall veins due to cirrhosis, the direction of blood flow is away from the umbilicus (radiating like a star from the umbilicus), whereas in vena caval obstruction, the direction of blood flow is either completely above downward (superior venacaval obstruction) or completely below upward (inferior venacaval obstruction). The technique of determining the direction of blood flow in a vein is described in standard clinical manuals. In inferior vena caval obstruction, anterior abdominal veins are dilated. To determine the direction of blood flow in a vein, first, the vein that is free from branches for a distance of 3 cm is identified. Second, 2 fingers are pressed close together and placed over the middle of the venous segment. Third, both fingers are moved in the opposite direction, “milking” and emptying the underlying vein; this results in complete emptying of the vein. Finally, 1 of the fingers is released, and the speed of the filling of the vein in one direction can be observed, and then the procedure is repeated in the other direction. Filling from below upward is slightly faster than the speed of filling from above downward (online video supplement is linked to this article). In the early phases of venous distension, this difference in flow rate will be clear. However, the valves of the vein become incompetent when the distension is long-term, and then the differences in flow rate will be less distinct.

Milk ejection disorders in Swiss dairy cows: a field study

A questionnaire was sent to 2099 dairy farms to investigate the occurrence of poor milkability. Based on that, the frequency of poor milkability in Swiss dairy cows was 4% and the percentage of cows treated with oxytocin (OT) was 2%. In addition, 270 dairy farms that had reported cases of animals with poor milkability were contacted for an interview to classify the disorders. Farmers suspected disturbed milk ejection in 52%, anatomical dysfunction of the teat and/or the udder in 16% and milk ejection disorder or impaired milkability caused by discernable environmental factors in 32% of the cases. Forty-eight animals from 18 farms with suspected milk ejection disorders were selected for an experimental field study which included milk flow recording and OT administration to induce milk ejection. After cessation of the spontaneous milk flow, a low dose of OT (0.2, 0.5 or 1 i.u.) was injected i.v. to test the responsiveness of the udder to OT at a physiological level. When milk flow ceased again, 10 i.u. OT was injected i.v. (supraphysiological) to ensure complete udder emptying and to determine the residual milk. Milk ejection disorder could be confirmed in 69% of the cases, i.e. if residual milk was >20% of the total milk. Because in 27% of the animals milk ejection disorder was not confirmed on the basis of elevated residual milk, an anatomical disorder of the teat and/or the udder was suspected. Milk ejection disorder could be confirmed in 69% of the cases whereas in 27% of the suspected cases an anatomical disorder of the teat and/or the udder was suspected. An increased cortisol production in cows with milk ejection disorder was not obvious because faecal concentrations of cortisol metabolites with a 5 beta-androstane-3 alpha,11 oxo-structure were not augmented in animals with disturbed milk ejection.

Prescrire des autosondages intermittents propres

Clean intermittent self-catheterization is the recommended mode of voiding in patients with urinary retention. CISC is a non-sterile catheterization, done by the patient himself to insure complete emptying of the bladder several times per day. Its prescription rests on well-established recommendations with a sufficient frequency of self-catheterization (minimum 4), collected volumes less than 400 mL and a diuresis higher than 1.5 L. Clean intermittent self-catheterization allows a reduction in complications of infection, protects the upper urinary tract and provides urinary continence for the patient. Asymptomatic bacteriuria is very frequent in patients treated with intermittent catheterization and does not justify antibiotic therapy. Only symptomatic urinary tract infections have to be treated by a short course of antibiotics. Patient education and personalized medical follow-up must ensure adapted management dependant on this voiding mode and its risk factors. A guideline is provided to prescribe clean intermittent self-catheterization with its indications, its advantages and complications, its medical surveillance and treatment of urinary tract infection. This procedure should be well-known to general practitioners who are responsible for the follow up of these patients.

La cæcostomie percutanée endoscopique pour traitement de l’incontinence fécale et de la constipation sévère : « l’intervention de Malone endoscopique »

Perendoscopic cecostomy has been proposed as an alternative to conventional surgical approach for Malone’s procedure. It avoid either laparotomy or laparoscopy. A complete colonic emptying is required to perform the endoscopic intervention. Preliminary results reported in the literature are promising.

Children's Self-Efficacy Scale: Initial Psychometric Studies

This article describes the development of a self-efficacy measure for elementary school children. A sample of 514 children, ages 8 to 11, enrolled in Grades 2 to 4 of public schools in Brazil was investigated. The scale included 78 descriptive items about academic situations, in which the child was required to respond on a 5-point scale, the frequency they felt capable of carrying out the proposed actions. An illustrative scale of fully shaded circles that gradually reduced to complete emptiness has also been used to visually display the categories of responses. The factorial analysis by principal axis and oblimin rotation suggested a two-factor structure explaining a variance of 40.54%. These factors were self-efficacy for studying and self-efficacy for academic performance. The Cronbach's alpha coefficients ranged from .80 to .83. The Rasch analysis indicates that only one item in the final scale did not fit the model.

Gynecologic-tract sparing extra peritoneal retrograde radical cystectomy with neobladder

We report on a series of female patients with transitional cell carcinoma of the bladder who underwent extraperitoneal retrograde radical cystectomy sparing the female reproductive organs with neobladder creation. 14 female patients between the ages of 45 and 72 years who underwent gynecologic-tract sparing cystectomy (GTSC) with neobladder between 1997 and 2002 were retrospectively reviewed. Our surgical technique is also described. Radical cystectomy is accomplished by a retrograde method sparing the uterus, adnexa, vagina and distal urethra. An orthotopic neobladder was constructed using small bowel or sigmoid colon, brought extraperitoneally, and anastomosed to the distal urethra. Operating time ranged from 4.5 to six hours with a mean of 5.3 hours. Ten patients were able to void satisfactorily while four required self-catheterization for complete emptying of the bladder. Seven patients were continent day and night and another 7 reported varying degrees of daytime and nighttime incontinence. One patient died of metastases and another of pelvic recurrence. There were no urethral recurrences. Patient satisfaction with the procedure was high. Gynecologic-tract sparing cystectomy with orthotopic neobladder is a viable alternative in female patients with muscle invasive traditional cell carcinoma of the bladder, providing oncological safety with improved quality of life. Our extraperitoneal technique, which is an extension of our successful experience with retrograde extraperitoneal radical cystectomy in men, minimizes intraoperative complications and simplifies the management of post-operative morbidity with the neobladder.

The gastric emptying of food as measured by gamma-scintigraphy and electrical impedance tomography (EIT) and its influence on the gastric emptying of tablets of different dimensions

A study in human volunteers has been designed to evaluate the influence of different food regimes on the gastric emptying of 3 mm and 10 mm diameter tablets. Dextrose and beef drinks were used as liquid food; a mixture of minced beef and mashed potato (shepherd's pie) was used as a solid meal. The gastric emptying of these foods was monitored simultaneously with electrical impedance tomography (EIT) and gamma-scintigraphy (GS), and was quantified in terms of the time before gastric emptying started, the lag time, the mean gastric residence time (MGRT) and its variance (VGRT), and the time for complete emptying. The gastric emptying time of the tablets was established by monitoring the position of the tablets, which had been labelled with suitable radio isotopes, by GS. The two systems for monitoring gastric emptying of the foods did not provide equivalent results: times obtained with EIT were generally shorter than those obtained with GS for the liquid foods, but were longer for the solid meal. There was only a slight difference in the emptying times of the two liquid foods, whereas values for MGRT, VGRT and the time for complete emptying were considerably longer for the solid meal. In nearly all instances the tablets emptied after the foods had emptied completely from the stomach. Gastric emptying times were longer for the 3 mm tablets than the 10 mm tablets, whatever food they were taken with. The difference between the median emptying times was significant when the meal was either a dextrose solution or a beef drink, but not when the meal was shepherd's pie. The increase in gastric emptying time of tablets induced by solid food was greater than that associated with the differences in tablet size. By providing a protocol that did not allow the administration of further food until after the tablets had emptied from the stomach, no tablet emptying times exceeded 6 h.

Neovesical‐urethral anastomotic stricture after orthotopic urinary diversion: presentation and management

To assess the frequency, presentation, treatment, and outcomes of bladder neck contractures (BNCs) among patients who had an orthotopic urinary diversion after radical cystectomy. We retrospectively examined our single-institution database of 788 patients who had a radical cystectomy from 1 January 1996 to 4 January 2006 for BNC; variables evaluated included presentation, degree of stricture/contracture, clinical management, and outcomes after management. Of the 374 patients who had an orthotopic urinary diversion, 11 (2.9%) men developed BNC; four BNCs were between 17 F and 22 F, six were <17 F, and one was pinhole-sized. Nine of the 11 patients presented with voiding difficulties, one in complete retention after complicated urinary tract infection, and one with new-onset nocturnal urinary incontinence. The treatment of BNC included cystoscopic dilatation in the clinic in six and under anaesthesia in three, and transurethral incision with a Collins knife or holmium laser in seven. After treatment, all patients were instructed to use continuous intermittent catheterization (CIC). Ten patients had follow-up data available after the intervention, with a mean (range) follow-up of 40.6 (10.6-98.0) months. Six patients were stricture-free for a mean period of 35.4 (10.6-98.0) months, while four patients had a recurrence within a mean of 7.4 (1.3-17.1) months. At the last follow-up, nine of the 10 patients were using CIC. No patient had significant daytime or night-time incontinence after treatment. BNC develops in a small proportion of patients undergoing orthotopic urinary diversion, with most patients presenting with voiding difficulty. Most will require transurethral incision rather than an office-based dilatation. After endoscopic incision to correct BNC, we recommend CIC to ensure complete emptying and to maintain the patency of the anastomotic stricture.

Systolic and Diastolic Pulsus Alternans in Severe Heart Failure

Pulsus alternans is usually a systolic phenomenon. We present a case of a patient with severe heart failure, and systolic and diastolic pulsus alternans. This case may help clarify the mechanism of pulsus alternans.

Chapitre A-l - Prise en charge chirurgicale des lithiases vésicales sur vessie neurologique

Bladder stones are common in neurological patients. As in other patients, bladder stones may reflect a voiding mode that fails to ensure complete bladder emptying, but they can also be due to more specific accidents, such as a foreign body introduced into the bladder during intermittent catheterization. Due to the frequency of this disease in neurological patients, the first step of treatment consists of correcting any vesico-sphincteric dyssynergia. Bladder stones can usually be easily removed based on a good knowledge of the management of this disease, which has become rare in the general population. This article presents the technical details and results of the various operations proposed in this setting.

Age‐Dependent Effects on Functional Aspects in Human Satellite Cells

In humans aging is a complex process that determines many physical and metabolic alterations correlated to the accumulation of oxidative damage in different tissues. Sarcopenia is an age-related nonpathological condition that includes a progressive loss of mass and strength in skeletal muscle, associated with a decline in the fibers' functional capability. This condition could be correlated to abnormal reactive oxygen species (ROS) accumulation with consequent fiber oxidative damage. This complex situation is not only evident in mature muscle fibers but also in muscle resident satellite cells (involved in fiber damage repairing) in which some functional parameters, at least for that concerns the Ca(2+) homeostasis, seem to be modified. In fact, our data show that there is an age-dependent increase of lipid peroxidation, in cultured myotubes (differentiated and fused satellite cells) after 7 days of in vitro differentiation. In these substrates also the capacity of these cells to produce Ca(2+) transient in response to various stimuli (ATP, caffeine, nicotine, KCl) is, sometimes, drastically modified. In particular, the presence of an age-dependent defective status of excitation-contraction (EC) coupling apparatus is supported by a single cell Ca(2+) analysis obtained from myotubes (derived from aged muscles) in the presence of 40 mM caffeine or 40 mM KCl. The alkaloid presence induces a complete emptying of ryanodine-dependent calcium stores indicating a probable integrity both of SR-terminal cisternae and/or the specific Ca(2+) channel known as RyR1. However, if a sarcolemmal depolarization is induced by the addition of 40 mM KCl in the experimental medium then Ca(2+) release RyR1-dependent can be observed only if Ca(2+) is present in the experimental solution. These results suggest that the EC uncoupling status could be due to the alteration of the interaction between RyR and DHPR. The two receptors are present and functionally active in myotubes from aged donors but they are probably still not in the right localization. These results suggest that during donor's life the satellite cells undergo an aging process similar to the one observed in skeletal muscle tissue, even if they are in a quiescence status for most of the time.

National survey on orthotopic neobladder

A national survey was conducted among the urologists in India to find the preference for urinary diversion after radical cystectomy for muscle invasive carcinoma of the urinary bladder, percentage of neobladder reconstruction, segment of the bowel used, complication rate, need for self-intermittent catherisation on follow up and the survival. A detailed questionnaire was mailed to all members of the urological society of India (USI) to find out their preference for urinary diversion following radical cystectomy for muscle invasive carcinoma urinary bladder. For the neobladder reconstruction, they were asked for the type of bowel segment used, complication rate, reoperation rate, need for intermittent clean catheterisation on follow up and 5-year survival. A total of 24 institutions responded to the mailed questionnaire. Of all institutions 12 (50%) did not prefer the orthotopic neobladder (ONB) reconstruction. Among the institutions carrying out neobladder reconstruction, majority perform ileal conduit in more than 50% of the cases. Ileum (66.66%) or ileocaecal (16.66%) segment was the choice of bowel segment for most of the urologists. Only three institutions used sigmoid colon. The complications encountered were wound infection (5-25%), burst abdomen (5%), urinary fistulas (3-25%), faecal fistulas (2-5%), bladder neck stenosis (5-15%) and ureterointestinal anastomosis stenosis (5-25%). The reoperation rate was 5-15% with a perioperative mortality of 0.5-3%. Around 10-100% (average 50%) of the patients require intermittent clean catherisation. Only seven institutions could provide 5-year survival rate data. Of these three institutions reported more than 50% and four institutes less than 50% 5-year survival. Ileal conduit still remains the urinary diversion of choice following radical cystectomy for muscle invasive carcinoma of the bladder among most of the urologists in India. Orthotopic neobladder reconstruction is practiced only in selected centres. Wound infection, urinary leak and obstruction at ureterointestinal anastomosis are the main complications. Clean intermittent cathaterisation is required at an average of 50% of the patients to ensure complete emptying of the neobladder.

Technical feasibility of laparoscopic Finney pyloroplasty examined in a canine model

The efficacy of laparoscopic surgery in the treatment of chronic duodenal ulcer has been demonstrated using minimally invasive approaches. This study aimed to evaluate the technical feasibility of laparoscopic Finney pyloroplasty in six dogs. Under laparoscopic guidance, the anastomosis was created using mechanical devices (n = 3) and combining a linear stapler device and intracorporeal suturing (n = 3). The operative time and complications were recorded. Evaluation of the anastomosis included studies of intraoperative and postoperative endoscopy and ultrasonography as well as the complete gastric emptying time. The animals were killed 4 weeks after surgery. Measurement of luminal diameter, amount of adhesion formation, degree of healing, and inflammation or fibrosis were evaluated in the postmortem studies. The operation was successfully completed for all the animals. No intraoperative or postoperative complications were observed. Gastric emptying was significantly enhanced in the postoperative period, as compared with the preoperative results. After 1 month, there was no evidence of anastomotic leak dehiscence at the gastroduodenal anastomosis. Luminal diameter was increased, and no abnormal findings were encountered during the postmortem abdominal exploration. The technical feasibility of performing a safe laparoscopic pyloroplasty in a dog model was demonstrated in this study.

Influence of temperature on urethra to bladder micturition reflex in the awake ewe

The flow of fluid along the urethra is known to facilitate detrusor contraction during micturition. This reflex, previously described in awake ewes, helps to achieve complete bladder emptying. In anesthetized cats, another urethra to bladder reflex involving urethral cold receptors has been described. The aim of this study was to investigate whether the urethral reflex first described in awake ewes could also be temperature-dependent. Experiments were performed on 10 healthy ewes. Urethral flows were performed by injecting 10 ml saline (ranging from 17 to 43 degrees C) at the level of the proximal urethra. Catheterization of the bladder was performed so that detrusor pressure was continually recorded during the experiments. Urethral flows using body temperature saline (37-39 degrees C) consistently evoked detrusor contraction. Urethral flows using saline at temperatures between 40 and 43 degrees C induced detrusor contractions that were not significantly different from those observed at 37-39 degrees C. Urethral flows using saline at temperatures below 37-39 degrees C (17-36 degrees C) resulted in a weaker or absent detrusor contraction. In ewes, we have shown that urethral to bladder micturition reflex involving mechanoreceptors is decreased at temperatures below the physiological range. It is suggested that transient receptor potential vanilloid cation channels (e.g., TRPV4 which is activated by sheer/stress flows at near-body temperature) could be involved in this urethra to bladder reflex. In humans, this reflex has hardly been described and is still a matter of debate. Our results reinforce that its full investigation may require systematic use of a range of saline flows at different temperatures.

A distinct subset of intestinal dendritic cells responds selectively to oral TLR7/8 stimulation

The intestinal innate immune system continually interacts with commensal bacteria, thus oral vaccines should induce extra/alternative activation of DC, potentially through TLR. To examine this we collected intestinal lymph DC (iL-DC) under steady-state conditions and after feeding resiquimod (R-848), a synthetic TLR7/8 ligand, which we showed induces complete emptying of gut DC into lymph. iL-DC are heterogeneous with subset-specific functions. In this study we determined the kinetics of iL-DC subset release, activation and cytokine secretion induced by R-848. We show that L-DC comprise three distinct subsets (CD172ahigh, CD172aint and CD172alow) present with similar frequencies in intestinal but not hepatic lymph. No iL-DC express TLR7 mRNA, and only CD172a+ iL-DC express TLR8. However, after oral R-848 administration, output of all three subsets increases dramatically. CD172ahigh DC release precedes that of CD172alow DC, and the increased frequency of CD25high iL-DC is restricted to the two CD172a+ subsets. After feeding R-848 only CD172ahigh iL-DC secrete IL-6 and IL-12p40. However, CD172aint and CD172ahigh DC secrete similar but markedly lower amounts when stimulated in vitro. These results highlight the importance of in vivo approaches to assess adjuvant effects on DC and give novel insights into the subset-specific effects of an oral TLR ligand on intestinal DC.

Uroflowmetry findings in patients with bladder outlet obstruction symptoms in standing and crouching positions.

Bladder emptying in crouching position is a conventional way in many eastern countries. Our aim was to evaluate uroflowmetry parameters as an index of obstruction severity in standing and crouching positions and comparison of them in patients with bladder outlet obstruction symptoms. Uroflowmetry in standing and crouching positions was done in 83 patients with bladder outlet obstruction symptoms due to benign prostatic hyperplasia (BPH). The patients were 50 years old or older and their maximum flow rate in standing position was less than 15 mL/s. The maximum flow rate, average flow rate, maximum flow time, and postvoid residual urine volume were measured and recorded. The results in standing and crouching positions were compared. The mean maximum flow rate and mean average flow rate in crouching position increased 86% and 51%, respectively (P < .001; P = .012), while mean maximum flow time and postvoid residual volume decreased 40% and 46%, respectively (P < .001; P < .001). These changes were also significant in patients with maximum flow rates of less than 10 mL/s and 10 mL/s to 15 mL/s in standing position, except for the maximum flow time in the latter group. A more complete emptying of bladder in crouching position in patients with BPH can be attributed to the increased bladder pressure due to a good transmission of intra-abdominal pressure and a complete and coordinated relaxation of pelvic floor muscles. This position can help improve patients' symptoms.

Bladder, Bowel and Bugs—Bacteriuria in Patients with Intestinal Urinary Diversion

The incorporation of intestinal segments into the urinary tract favors bacterial growth of the skin flora, anaerobic bacteria, and uropathogenic strains. The route of infection is ascending; bacteria enter the urethra or the abdominal stoma, which is followed by colonization of the reconstructed lower urinary tract. Bacteriuria is common in all kind of reconstructions; however, urine from neobladder patients with complete emptying is reported to carry bacteria to a lesser extent. Clean intermittent catheterization and residual urine seem to increase the bacterial burden. Patients with augmentation cystoplasties constitute a distinct subgroup in which the remaining part of the bladder tissue is an important determinant of urinary tract susceptibility to infection. The increased rate of bacteriuria in the reconstructed patients indicates a lack of “antibacterial defenses”, and the symptom free state of the patients suggests that only a restricted host response is triggered. The role of the specific and inflammatory antibacterial defenses in the reconstructed lower urinary tract remains largely unknown.

Factors influencing bowel function after ileal pouch-anal anastomosis.

Seventeen patients were studied 3-31 months (median 6.4 months) after mucosal proctectomy and ileal pouch-anal anastomosis for ulcerative colitis (n = 15) or adenomatous polyposis (n = 2). Seven had a triplicated pouch, and ten a duplicated pouch. Clinical bowel function was determined by detailed questionnaire, and correlations sought between clinical end-points such as frequency of defaecation, urgency of defaecation and continence, and the results of laboratory investigations, comprising anal manometry, capacity and compliance of the pouch, completeness of emptying, faecal bacteriology and mucosal inflammation. Frequency of defaecation was found to be inversely correlated with both the capacity (rs = -0.66, P less than 0.01) and the compliance (rs = -0.53, P less than 0.05) of the pouch. Patients who could postpone defaecation for greater than 30 min had higher anal squeeze pressures (P less than 0.05) than patients who had greater urgency of defaecation. Patients with perfect anal continence had higher resting anal pressure (P less than 0.05) and emptied the pouch more completely (P less than 0.01) than patients who experienced minor leakage. The faecal flora of the pouches showed a greater predominance of anaerobes (P less than 0.01) and increased numbers of bacteroides (P less than 0.01) compared with the faecal flora of ileostomies, but the changes in the flora did not correlate with any aspect of bowel function. The best clinical results (i.e. perfect continence, low frequency of defaecation and little urgency) were associated with high anal pressure and with large volume, high compliance and complete emptying of the pouch. The completeness of emptying was similar for both designs of pouch, but the capacity and compliance of triplicated pouches were greater than the capacity and compliance of duplicated J pouches (P less than 0.05), and this was associated with a better clinical result in the triplicated pouches.

A comparison of gastric emptying at 3 and 12 months after proximal gastric or selective vagotomy without pyloroplasty.

Abstract A prospective study was performed to determine whether the early postoperative disturbance of gastric emptying after vagotomy altered with the passage of time. In 20 patients the rate of emptying of a 10 per cent dextrose meal was measured by a double sampling dye dilution technique before and 3 months after proximal gastric vagotomy or selective vagotomy without a drainage procedure. Ten of these patients agreed to a further emptying study at 12 months after operation. Profound changes in the pattern of emptying occurred as a result of either operation. At 3 months after operation both selective and proximal gastric vagotomy were associated with an initial cascading of part of the meal (gastric incontinence). Selective vagotomy was then associated with an increase in the time taken for complete emptying, whereas after proximal gastric vagotomy the time taken for complete emptying was similar to that before surgery. In the next 9 months after operation no significant change occurred in the initial cascading, but the delay in complete emptying after selective vagotomy improved in some patients.

Effect of corporal and antral gastrojejunostomy on canine gastric emptying of solid spheres and liquids.

Abstract Gastric emptying of solids and liquids was measured in 12 dogs with and without corporal or antral gastrojejunostomy. Both types of stoma hastened the onset but did not alter the time from onset to complete emptying of 40 small plastic spheres. Corporal gastrojejunostomy slowed the emptying of 400 ml. of 154 mM NaCl but not of 500 mM glucose, whereas antral gastrojejunostomy slowed the emptying of both.