Expulsion Time Research Articles

Efficacy and Safety of Alfuzosin as Medical Expulsive Therapy for Ureteral Stones: A Systematic Review and Meta-Analysis.

BackgroundAlfuzosin has been widely used to treat benign prostatic hyperplasia and prostatitis, and is claimed to be a selective agent for the lower urinary tract with low incidence of adverse side-effects and hypotensive changes. Recently, several randomized controlled trials have reported using Alfuzosin as an expulsive therapy of ureteral stones. Tamsulosin, another alpha blocker, has also been used as an agent for the expulsive therapy for ureteral stones. It is unclear whether alfuzosin has similar efficacy as Tamsulosin in the management of ureteral stones.ObjectiveTo perform a systematic review and analysis of literatures comparing Alfuzosin with Tamsulosin or standard conservative therapy for the treatment of ureteral stones less than 10 mm in diameter.MethodsA systematic literature review was performed in December 2014 using Pubmed, Embase, and the Cochrane library databases to identify relevant studies. All randomized and controlled trials were included. A subgroup analysis was performed comparing Alfuzosin with control therapy on the management of distal ureteral stones.ResultsAlfuzosin provided a significantly higher stone-free rate than the control treatments (RR: 1.85; 95% confidence interval [CI], 1.35–2.55; p<0.001), and a shorter stone expulsion time (Weighted mean difference [WMD]: -4.20 d, 95%CI, -6.19 to -2.21; p<0.001), but it has a higher complication rate (RR: 2.02; 95% CI, 1.30–3.15; p<0.01). When Alfuzosin was compared to Tamsulosin, there was no significant difference in terms of stone-free rate (RR: 0.90; 95% CI, 0.79–1.02; p = 0.09) as well as the stone expulsion time (WMD: 0.52 d, 95%CI, -1.61 to 2.64; p = 0.63). The adverse effects of Alfuzosin were similar to those of Tamsulosin (RR: 0.88; 95% CI, 0.61–1.26; p = 0.47).ConclusionsAlfuzosin is a safe and effective agent for the expulsive therapy of ureteral stones smaller than 10 mm in size. It is more effective than therapeutic regiment without alpha blocker. It is equivalent to Tamsulosin in its effectiveness and safety profile. Adverse effects should always be kept in mind when use this class of drugs.

Spexin Enhances Bowel Movement through Activating L-type Voltage-dependent Calcium Channel via Galanin Receptor 2 in Mice

A novel neuropeptide spexin was found to be broadly expressed in various endocrine and nervous tissues while little is known about its functions. This study investigated the role of spexin in bowel movement and the underlying mechanisms. In functional constipation (FC) patients, serum spexin levels were significantly decreased. Consistently, in starved mice, the mRNA of spexin was significantly decreased in intestine and colon. Spexin injection increased the velocity of carbon powder propulsion in small intestine and decreased the glass beads expulsion time in distal colon in mice. Further, spexin dose-dependently stimulated the intestinal/colonic smooth muscle contraction. Galanin receptor 2 (GALR2) antagonist M871, but not Galanin receptor 3 (GALR3) antagonist SNAP37899, effectively suppressed the stimulatory effects of spexin on intestinal/colonic smooth muscle contraction, which could be eliminated by extracellular [Ca2+] removal and L-type voltage-dependentCa2+ channel (VDCC) inhibitor nifedipine. Besides, spexin dramatically increased the [Ca2+]i in isolated colonic smooth muscle cells. These data indicate that spexin can act on GALR2 receptor to regulate bowel motility by activating L-type VDCC. Our findings provide evidence for important physiological roles of spexin in GI functions. Selective action on spexin pathway might have therapeutic effects on GI diseases with motility disorders.

Effect of oil palm phenolics on gastrointestinal transit, contractility and motility in the rat

The effects of a novel water soluble polyphenolics preparation (oil palm phenolics; OPP) on whole gastrointestinal transit, ex vivo proximal and distal colonic contractility and intact expulsion time in the distal colon were examined. Nine weeks of dietary supplementation with OPP at 50 mg gallic acid equivalents (GAE)/rat per day had no effect on gastric emptying compared to the control (AIN-93M), but 30% substituted high amylose maize starch (HAMS) used as a positive resistant starch control, had significantly higher gastric emptying compared to both control and OPP. OPP increased distal colonic contractile response to KCl, PGE2 and angiotensin I compared with the control, whilst HAMS also had similar increased contractile responses. This correlated with faster distal colonic expulsion rates for OPP and HAMS compared with the control. The present study revealed that OPP, like resistant starch, has positive effects on distal colonic contractility and motility with potential putative roles in bowel function and health.

Can Sexual Intercourse Be an Alternative Therapy for Distal Ureteral Stones? A Prospective, Randomized, Controlled Study

To investigate the effect of sexual intercourse on spontaneous passage of distal ureteral stones. The patients were randomly divided into 3 groups with random number table envelope method. Patients in group 1 were asked to have sexual intercourse at least 3-4 times a week. Patients in group 2 were administered tamsulosin 0.4 mg/d. Patients in group 3 received standard medical therapy alone and acted as the controls. The expulsion rate was controlled after 2 and 4 weeks. Differences in the expulsion rate between groups were compared with the chi-square test for 3 × 2 tables. P <.05 was considered as statistically significant. The mean stone size was 4.7 ± 0.8 mm in group 1, 5 ± 1 mm group 2, and 4.9 ± 0.8 mm group 3 (P = .4). Two weeks later, 26 of 31 patients (83.9%) in the sexual intercourse group, and 10 of 21 patients (47.6%) in tamsulosin group passed their stones, whereas 8 of 23 patients (34.8%) in the control group passed their stones (P = .001). The mean stone expulsion time was 10 ± 5.8 days in group 1, 16.6 ± 8.5 days in group 2, and 18 ± 5.5 days in group 3 (P = .0001). Our results have indicated that patients who have distal ureteral stones ≤6 mm and a sexual partner may be advised to have sexual intercourse 3-4 times a week to increase the probability of spontaneous passage of the stones.

Quantitative estimation of overpressure caused by gas generation and application to the Baiyun Depression in the Pearl River Mouth Basin, South China Sea

AbstractHydrocarbon generation can yield high fluid pressures in sedimentary basins as the conversion of solid kerogen to hydrocarbons can result in an increase in fluid volume. To quantify the relationship between gas generation and overpressure in source rocks, a set of equations for computing the pressure change due to gas generation has been derived. Those equations can be used to quantitatively estimate overpressure generated by type III kerogen in source rocks by considering gas generation and leakage, gas dissolution in formation water and residual oil, thermal cracking of oil to gas, and hydrocarbon episodic expulsion from source rocks. The equations also take consideration of other factors including source rock porosity, transformation ratio, total organic carbon (TOC), hydrogen index, and compressibility of kerogen, oil, and water. As both oil and gas are taken into account in the equations, they can also be used to estimate the evolution of overpressure caused by hydrocarbon generation of type I and type II kerogen source rocks. Sensitivity analyses on the type III kerogen source rock indicate that hydrogen index is the most influential parameter for overpressure generation, while TOC and residual gas coefficient (β: ratio of residual gas over the total gas generated) have a moderate effect. Overpressure can be generated even if the gas leakage/loss in the source rock is up to 80% of the total gas generated. This suggests that the internal pressure seal of the source rock is not a critical factor on the pressure change as long as the source rocks are capable of sealing liquid oil. The equations were applied to evaluate the overpressure in the Eocene–Oligocene Enping Formation source rocks due to hydrocarbon generation in the Baiyun Depression, the Pearl River Mouth Basin by considering the source rock properties, hydrocarbon generation history, and hydrocarbon expulsion timing. Two episodes of overpressure development due to gas generation and release were modeled to have occurred in the Enping Formation source rock since 16 Ma. The overpressure release at 10.2–5.3 Ma via hydrocarbon expulsion was apparently related to the Dongsha phase of tectonic deformation, whereas the pressure release at 2–0 Ma was due to pressure generation that was exceeded the fracture‐sealing pressure in the source rocks.

Alfuzosin Treatment Improves The Rate and Time for Stone Expulsion in Patients with Distal Uretral Stones: A Prospective Randomized Controlled Study

To evaluate the safety and efficacy of alfuzosin treatment on rate and time of stone expulsion in patients with uncomplicated distal ureteral stones. Prospective, randomized, open-label, controlled study. Patients >18years of age presenting to the outpatient urology clinic with uncomplicated radio-opaque stones located in the distal third of the ureter and of size ≤10mm were included. Patients were randomly assigned to either a control group (n=26) and received standard of care management (daily oral hydration and diclofenac 75mg IM on demand) or to the alfuzosin group (n=28) and received alfuzosin SR 5mg twice daily in addition to standard of care management. Patients were followed weekly at office visits and twice weekly by telephone for 4weeks or until stone expulsion. Assessments included stone passage rate and time, and patients were monitored for occurrence of adverse drug events, complications, number of pain episodes, analgesic consumption, and number of hospital revisits. Mann-Whitney, χ(2) , and Fisher exact test were used for data analysis. All 54 patients completed the study. Stone expulsion rate was higher in the alfuzosin arm (53.6%, 15/28) compared to the control arm (26.9%, 7/26, p=0.04). Median stone passage time was lower in the alfuzosin group than in the control group (9 vs 19days, respectively, p=0.006). Ureteral sepsis, uncontrollable pain, and hospitalization readmissions were reported in the control group only. There were no differences between groups in number of pain episodes, pain scores, or analgesic consumption. Alfuzosin therapy was tolerable with only minor adverse effects (headache, dizziness, mild postural hypotension, and rhinitis). Alfuzosin is safe and effective in increasing stone expulsion rates and shortening stone passage times for uncomplicated distal ureteral stones.

Development of chronic pain after episiotomy

ObjectiveTo analyze the incidence of chronic pain 5 months after episiotomy, as well as potential prognostic factors. MethodsA prospective cohort observational study was conducted on pregnant women age≥18 years who had undergone an episiotomy. The presence of pain was evaluated in the area of episiotomy at 24 and 48h of delivery using a structured face-to-face questionnaire, and by telephone questionnaire at 5 months. The primary endpoint was the presence of persistent pain at 5 months. A record was made of the presence of pain at delivery, and its intensity, the presence or absence of epidural analgesia, instrumental delivery, perineal tear, and pain when episiotomy was performed, as well as the presence of dyspareunia and urinary incontinence at 5 months post-episiotomy. ResultsA total of 87 parturient patients were included, of whom 78 completed the study. Of the patients who completed the study, 12.8% reported chronic episiotomy pain. Epidural analgesia was associated with a higher incidence of instrumental delivery and less pain at the time of episiotomy and expulsion (P<.0005, P<.02, and P<.01, respectively). Chronic pain is associated with operative delivery (P<.017), and with the presence of pain at rest at 24 and 48h (P<.01), of wound complications (P<.026), and of dyspareunia (P<.001). ConclusionAn incidence of 12.8% of women developing chronic pain after delivery with episiotomy suggests a health problem. More studies are needed to confirm our results.

Expression of oxytocin receptors is greatly reduced in the placenta of heavy mares with retained fetal membranes due to secondary uterine atony.

Fetal membrane retention can be a life-threatening condition and its incidence exceeds 50% in heavy draught mares. Although fetal membrane retention is commonly treated with repeated injections of oxytocin, based on the suggestion that it is caused mainly by secondary atony of the uterus, this treatment sometimes fails. This led us to ask if expression of oxytocin receptors differs in mares that retain fetal membranes due to secondary uterine atony. To determine whether expression of oxytocin receptors in equine placental tissues differs when heavy draught mares expel fetal membranes or retain them because of secondary uterine atony. Controlled study using archived tissues. Placental biopsies (containing the endometrium and allantochorion) were taken from 8 heavy draught mares during parturition. Four mares expelled fetal membranes shortly after foaling (control mares) and 4 mares retained them (expulsion time was >3 h from delivery). The 4 mares that retained fetal membranes had secondary atony of the uterus. The amount of oxytocin receptors was estimated by measuring the intensity of western blot bands. The presence and location of oxytocin receptors were determined by immunocytochemistry. Oxytocin receptor expression was nearly 50 times less intense in mares with placenta retention due to secondary atony of the uterus and immunocytochemical staining was barely visible. In the control mares, oxytocin receptors were found in both epithelial and endothelial cells of the placenta and staining was most intense where the endometrium contacts the allantochorion. Inadequate expression of oxytocin receptors may be a cause of uterine atony leading to fetal membrane retention.

The Efficacy and Safety of Tamsulosin Combined with Extracorporeal Shockwave Lithotripsy for Urolithiasis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Many studies have been conducted to investigate adjunctive tamsulosin therapy after extracorporeal shockwave lithotripsy (SWL) for urolithiasis. The results from those studies, however, are still inconsistent. Therefore, we performed a meta-analysis to provide an update on the clinical efficacy and safety of tamsulosin combined with SWL for urolithiasis. A systematic search was performed in PubMed, Cochrane Library, and Embase to identify all relevant randomized controlled trials until January 2015. Two reviewers independently assessed trial quality and extracted data. Meta-analysis was conducted with Review Manager (RevMan), version 5.1. Twenty-one studies (2093 subjects in total) were identified in the current meta-analysis. Compared with a control group, the experimental group (tamsulosin combined with SWL) showed an increased overall benefit for stone expulsion, with pooled risk ratio (RR) of 1.20 (95% confidence interval [CI], 1.15-1.26). With respect to the different geographic regions, European and American had a high possibility of improvement in stone expulsion (RR: 1.33, 95% CI, 1.19-1.49). According to the stone locations (renal, upper and lower ureteral) and sizes (4-10 mm and 11-24 mm), tamsulosin is more useful for lower ureteral stone (RR: 1.28; 95% CI, 1.14-1.43) and larger sized stones (RR: 1.49; 95% CI, 1.28-1.75). The effect estimates did not vary markedly when stratified by follow-up durations but varied by dose of tamsulosin. Furthermore, a shorter expulsion time, reduced occurrence of steinstrasse, fewer incidences of colic, and lower analgesic requirements were observed within the experimental group. In addition, tamsulosin is well tolerated, and its adverse events rarely led to dropouts of patients. Overall, evidence suggests that tamsulosin combined with SWL is safe and effective in enhancing stone expulsion for patients with urolithiasis. Furthermore, high-quality, randomized and placebo-controlled trials evaluating the efficacy and safety of tamsulosin should be performed.

75 In Combat Soldiers Resting Urinary Metabotypes Correlate With the Development of Gastrointestinal Symptoms During Stress

Introduction: Western-diet (WD) is associated with reduced stool frequency in humans. High-fat fed mice exhibit delayed gastrointestinal (GI) transit associated with reduced number of nitrergic myenteric neurons. Mechanisms of these alterations are still unknown. Our aim was to investigate if WD feeding leads to modifications of fecal metabolites associated with the development of enteric neurodegeneration and the role played by the gut microbiota in such phenomenon. Methods: C57Bl/6 mice were fed a WD (34.5% kcal from fat, representative of the typical American diet fat calorie intake, n=5) or a Regular diet (RD, 16.9% kcal from fat, n=5). 6 weeks post feeding, fecal metabolites were analyzed by high-resolution mass spectrometry (LTQ-FT). 12 weeks post feeding, nitrergic myenteric neurons were quantified in the proximal colon by NADPH-diaphorase staining and GI and colonic transit were measured. Citrulline was measured by ELISA in germ-free (GF) mice stools fed a WD or a RD for 6 weeks (n=3 per group). Data are presentedas mean ± SEM and are significant to p < 0.05. Results: After 12 weeks of feeding, WD mice exhibited a reduced stool frequency in comparison to RD mice (1.5±0.5 and 4.4±0.3 stools/min, respectively) and this was associated with a delayed intestinal transit time (281.5±57.5 and 152.8±15.7 min). In addition, WD mice had a longer colonic transit time (as measured by bead expulsion time: WD: 127.5±52.5 min; RD: 13.2±2.0 min) associated with reduced number of nitrergic myenteric neurons in the proximal colon (113.0±5.6 and 64.2±7.4 neurons/field). Together, these data demonstrate an altered colonic motor function after 12 weeks of WD. We quantified 3730 metabolites in the feces but only 185 were significantly higher in WD mice compared to RD mice. In addition to palmitate, we found increased concentrations of citrulline (associated with enhanced nitric oxide synthase activity), 3-hydroxykynurenine (reflecting neuroinflammation) and bacterial muramic acid [Figure 1]. In order to understand the possible role of the gut microbiota in these changes, we measured fecal citrulline in GF mice fed a WD or a RD for 6 weeks and found similar concentrations (3.0±0.5 and 2.6±0.3 ng/mg). Conclusion: Our results show that long-term WD consumption is associated with nitrergic myenteric neuronal loss contributing to delayed GI transit. These alterations were preceded by gut dysbiosis and elevated fecal citrulline, potentially reflecting higher plasma concentrations that lead to oxidative stress and apoptosis in NO producing neurons. Importantly, fecal citrulline was not affected by a WD feeding under germfree conditions, suggesting that the gut microbiota is required for such effects. Fecal citrulline may be considered as a marker of myenteric neuronal impairments responsible for the motor alterations observed during WD feeding.

74 Fecal Metabolites Associated With Nitrergic Myenteric Neuronal Impairment and Gastrointestinal Motility Disorders in Western Diet-Fed Mice

Introduction: Western-diet (WD) is associated with reduced stool frequency in humans. High-fat fed mice exhibit delayed gastrointestinal (GI) transit associated with reduced number of nitrergic myenteric neurons. Mechanisms of these alterations are still unknown. Our aim was to investigate if WD feeding leads to modifications of fecal metabolites associated with the development of enteric neurodegeneration and the role played by the gut microbiota in such phenomenon. Methods: C57Bl/6 mice were fed a WD (34.5% kcal from fat, representative of the typical American diet fat calorie intake, n=5) or a Regular diet (RD, 16.9% kcal from fat, n=5). 6 weeks post feeding, fecal metabolites were analyzed by high-resolution mass spectrometry (LTQ-FT). 12 weeks post feeding, nitrergic myenteric neurons were quantified in the proximal colon by NADPH-diaphorase staining and GI and colonic transit were measured. Citrulline was measured by ELISA in germ-free (GF) mice stools fed a WD or a RD for 6 weeks (n=3 per group). Data are presentedas mean ± SEM and are significant to p < 0.05. Results: After 12 weeks of feeding, WD mice exhibited a reduced stool frequency in comparison to RD mice (1.5±0.5 and 4.4±0.3 stools/min, respectively) and this was associated with a delayed intestinal transit time (281.5±57.5 and 152.8±15.7 min). In addition, WD mice had a longer colonic transit time (as measured by bead expulsion time: WD: 127.5±52.5 min; RD: 13.2±2.0 min) associated with reduced number of nitrergic myenteric neurons in the proximal colon (113.0±5.6 and 64.2±7.4 neurons/field). Together, these data demonstrate an altered colonic motor function after 12 weeks of WD. We quantified 3730 metabolites in the feces but only 185 were significantly higher in WD mice compared to RD mice. In addition to palmitate, we found increased concentrations of citrulline (associated with enhanced nitric oxide synthase activity), 3-hydroxykynurenine (reflecting neuroinflammation) and bacterial muramic acid [Figure 1]. In order to understand the possible role of the gut microbiota in these changes, we measured fecal citrulline in GF mice fed a WD or a RD for 6 weeks and found similar concentrations (3.0±0.5 and 2.6±0.3 ng/mg). Conclusion: Our results show that long-term WD consumption is associated with nitrergic myenteric neuronal loss contributing to delayed GI transit. These alterations were preceded by gut dysbiosis and elevated fecal citrulline, potentially reflecting higher plasma concentrations that lead to oxidative stress and apoptosis in NO producing neurons. Importantly, fecal citrulline was not affected by a WD feeding under germfree conditions, suggesting that the gut microbiota is required for such effects. Fecal citrulline may be considered as a marker of myenteric neuronal impairments responsible for the motor alterations observed during WD feeding.

MP41-06 ADMINISTRATION OF THE SELECTIVE ALPHA 1A ADRENOCEPTOR ANTAGONIST SILODOSIN FACILITATES EXPULSION OF SIZE 5 - 10 MM DISTAL URETERAL STONES, AS COMPARED TO CONTROL.

You have accessJournal of UrologyStone Disease: Medical Therapy1 Apr 2015MP41-06 ADMINISTRATION OF THE SELECTIVE ALPHA 1A ADRENOCEPTOR ANTAGONIST SILODOSIN FACILITATES EXPULSION OF SIZE 5 - 10 MM DISTAL URETERAL STONES, AS COMPARED TO CONTROL. Yasunori Itoh, Atsushi Okada, Kazumi Taguchi, Yasuhiko Hirose, Yasuhiro Fujii, Takahiro Kobayashi, Masayuki Usami, Shuzo Hamamoto, Masahito Hirose, Takahiro Yasui, Keiichi Tozawa, Shoichi Sasaki, Yutaro Hayashi, and Kenjiro Kohri Yasunori ItohYasunori Itoh More articles by this author , Atsushi OkadaAtsushi Okada More articles by this author , Kazumi TaguchiKazumi Taguchi More articles by this author , Yasuhiko HiroseYasuhiko Hirose More articles by this author , Yasuhiro FujiiYasuhiro Fujii More articles by this author , Takahiro KobayashiTakahiro Kobayashi More articles by this author , Masayuki UsamiMasayuki Usami More articles by this author , Shuzo HamamotoShuzo Hamamoto More articles by this author , Masahito HiroseMasahito Hirose More articles by this author , Takahiro YasuiTakahiro Yasui More articles by this author , Keiichi TozawaKeiichi Tozawa More articles by this author , Shoichi SasakiShoichi Sasaki More articles by this author , Yutaro HayashiYutaro Hayashi More articles by this author , and Kenjiro KohriKenjiro Kohri More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1634AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recently, we reported that alpha 1A adrenoceptor (AR) is the main participant in phenylephrine-induced human ureteral contraction. We therefore decided to carry out a prospective randomized study to evaluate the effects of silodosin, a selective alpha 1A AR antagonist, as a medical expulsive therapy (MET) for distal ureteral stones. METHODS A total of 112 male patients, who were referred to our department for the management of symptomatic unilateral distal ureteral calculi of less than 10 mm, were randomly divided into two groups: group A (56 patients) who were instructed to drink 2 L of water daily and group B (56 patients) who received the same instruction and were also given silodosin (8 mg/daily) for a maximum of 4 weeks. Expulsion rate, expulsion time and need for analgesics were examined. RESULTS The expulsion rate was 55.3% (56 patients) for group A and 72.7% (55 patients) for group B (P = 0.106). The expulsion rate for < 5 mm was 92.9% (28 patients) for group A and 69.2% (26 patients) for group B (P =0.053). The expulsion rate for > or = 5 mm was 17.9% (28 patients) for group A and 75.9% (29 patients) for group B (P =0.001). The expulsion time was 13.40 ± 5.90 and 9.29 ± 5.91 days, respectively (P = 0.012). Analgesics were required 1.5 ± 3.1 and 0.3 ± 0.9 times, respectively (P = 0.382). Stone size in expulsion cases was 3.64 ± 1.25 and 5.23 ± 2.32 mm, respectively (P = 0.003). In all stone sizes, group B showed high expulsion rate (Fig.). CONCLUSIONS Due to the high likelihood of spontaneous passage of stones up to 5 mm, MET is less likely to increase the stone-free rate. Here, we have shown that MET for distal ureteral stones by silodosin was effective for stones ≥5 mm. Silodosin is used in Japan, the United States, Korea, Germany, Lebanon, Ireland, Spain, France, Portugal, Belgium, Romania, Taiwan, Italy, Greece, Netherland, Russia, Czech, Slovakia, Canada, Bulgaria, Cyprus, Turkey, Poland, Ukraine, Georgia, and China. We believe that silodosin might have potential as a MET for distal ureteral stones. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e502 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yasunori Itoh More articles by this author Atsushi Okada More articles by this author Kazumi Taguchi More articles by this author Yasuhiko Hirose More articles by this author Yasuhiro Fujii More articles by this author Takahiro Kobayashi More articles by this author Masayuki Usami More articles by this author Shuzo Hamamoto More articles by this author Masahito Hirose More articles by this author Takahiro Yasui More articles by this author Keiichi Tozawa More articles by this author Shoichi Sasaki More articles by this author Yutaro Hayashi More articles by this author Kenjiro Kohri More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Predictive parameters for medical expulsive therapy in ureteral stones: a critical evaluation.

To evaluate the predictive value of some certain radiological as well as stone-related parameters for medical expulsive therapy (MET) success with an alpha blocker in ureteral stones. A total 129 patients receiving MET for 5 to 10 mm ureteral stones were evaluated. Patients were divided into two subgroups where MET was successful in 64 cases (49.61%) and unsuccessful in 65 cases (50.39%). Prior to management, stone size, location, position in the ureter, degree of hydronephrosis, diameter of ureteral lumen proximal to the stone, ureteral wall thickness along with patient's demographics including body mass index (BMI) values were evaluated and recorded. The possible predictive values of these parameters for stone expulsion (and stone expulsion time) were evaluated in a comparative manner between two groups. The overall mean patient age and stone size values were 38.02 ± 0.94 years and 40.31 ± 1.13 mm(2), respectively. Regarding the predictive values of these parameters for MET-success, while stone size and localization, degree of hydronephrosis, proximal ureteral diameter and ureteral wall thickness were found to be highly predictive for MET-success, patients age, BMI values and stone density had no predictive value on this aspect. Our findings indicated that some stone and anatomical factors may be used to predict the success of MET in an effective manner. With this approach unnecessary use of these drugs that may cause a delay for stone removal will be avoided and the possible adverse effects of obstruction as well as stone-related clinical symptoms could be minimized.

Toll-like receptor 4 contributes to the inhibitory effect of morphine on colonic motility in vitro and in vivo.

Opioids rank among the most potent analgesic drugs but gastrointestinal side effects, especially constipation, limit their therapeutic utility. The adverse effects of opioids have been attributed to stimulation of opioid receptors, but emerging evidence suggests that opioids interact with the innate immune receptor Toll-like receptor 4 (TLR4) and its signalling pathway. As TLR4 signalling affects gastrointestinal motility, we examined the involvement of TLR4 in morphine-induced depression of peristaltic motility in the guinea-pig intestine in vitro and male C57BL/6N mice in vivo. While the TLR4 antagonist TAK-242 (0.1 μM and 1 μM) did not alter the morphine-induced inhibition of peristalsis in the isolated guinea-pig small intestine, the morphine-induced decrease in pellet propulsion velocity in colonic segments was attenuated by TAK-242 (0.1 μM). The ability of TAK-242 (4 mg/kg) to mitigate the morphine-induced suppression of colonic motility was replicated in mice in vivo by measuring the expulsion time of beads inserted in the distal colon. The inhibition of upper gastrointestinal transit of mice by morphine was not affected by pre-treatment with TAK-242 (4 mg/kg) in vivo. This is the first report that morphine-induced inhibition of colonic peristalsis is alleviated by TLR4 antagonism. We therefore conclude that TLR4 may contribute to opioid-induced constipation.

Induction of Sda-sialomucin and sulfated H-sulfomucin in mouse small intestinal mucosa by infection with parasitic helminth

Mucin is a major component of mucus on gastrointestinal mucosa. Mucin alteration in the host is considered to be the principal event for expulsion of intestinal helminths. However, it is unclear what mucin alterations are induced by various helminth infections. In this study, the alterations of mouse small intestinal mucin after infection with two nematodes, Nippostrongylus brasiliensis and Heligmosomoides polygyrus, which parasitize the jejunal epithelium, and a cestode, Vampirolepis nana, which parasitizes the ileal epithelium, were examined biochemically and histologically using two anti-mucin monoclonal antibodies (mAbs), HCM31 and PGM34, which recognize Sda antigen, NeuAcα2–3(GalNAcβ1–4)Galβ1-4GlcNAcβ-, and sulphated H type 2 antigen, Fucα1-2Galβ1-4GlcNAc(6SO3H)β-, respectively. The goblet cell mucins that reacted with HCM31 increased conspicuously on the jejunal mucosa concurrently with expulsion of N. brasiliensis. Increased levels of HCM31-reactive mucins were observed in the jejunal mucosa after H. polygyrus infection, despite the ongoing parasitism. Goblet cell mucins that reacted with PGM34 increased on the ileal mucosa during V. nana parasitism. Small intestinal goblet cells reacting with the two mAbs were not observed in non-infected mice, although sialomucins and sulfomucins were abundantly present. Additionally, the number of ileal goblet cells that reacted with the two mAbs was increased at the time of expulsion of heterophyid trematode. These results indicate that the type of specific acidic mucins expressed after infection varies among species of intestinal helminth, and, furthermore, that the relationship with worm expulsion is also different.

Role of removing stasis and reducing heat formula in clearance of proximal ureteral calculi after ureteroscopic Ho:YAG laser lithotripsy: a prospective randomized study.

To prospectively evaluate the efficacy of Removing Stasis and Reducing Heat Formula in accelerating calculus clearance and improving lower urinary tract symptoms of patients with proximal ureteral calculi after ureteroscopic Ho:YAG laser lithotripsy. A total of 138 patients with proximal ureteral calculi underwent ureteroscopic Ho:YAG laser lithotripsy by a single endocrinologist. Stone size varied from 10 to 15 mm. After operation, the patients were randomly divided into three groups: the control group (group A), tamsulosin group (group B), and Removing Stasis and Reducing Heat Formula group (group C). The treatment lasted for 4 weeks or until stone clearance. The primary and secondary outcomes of the three groups at follow-up were assessed. Of the 131 patients available for follow-up, 44 cases were in the group A, 45 in the group B, and 42 in the group C, respectively. The stone free rate at 2 weeks in the groups B and C were significantly higher than that in the group A (95.56%, 97.62% vs. 79.55%; all P<0.05). The ureteral colic rate and mean time of fragment expulsion were significantly reduced in the groups B (4.44% and 7.86±4.99 days) and C (2.43% and 6.76±4.37 days) compared with the group A (22.73% and 11.54±9.89 days, all P<0.05). On the day of double-J ureteric stent removal, the group C differed significantly from the group A in the total International Prostate Symptom Score, irritative subscore, obstructive subscore, and quality of life score (all P<0.05). Removing Stasis and Reducing Heat Formula in the medical expulsive therapy might be an effective modality for patients with calculus in the proximal uretera after ureteroscopic Ho:YAG laser lithotripsy.

Uterine Atony: An Innovative Dutta's Scoring System for Elective Cesarean Section

ABSTRACT Uterine atony appears suddenly and is mostly unpredictable and accounts for 80% of causes of postpartum hemorrhage (PPH), it is also one of the important causes of maternal death. Objective To analyze the efficacy of Dutta's score for early diagnosis and management of uterine atony during elective lower segment cesarean section (LSCS) to prevent PPH. Study methods: This study was undertaken at JNM, NSGH, CN at Kalyani, Nadia, West Bengal, India, from 1st June 2008 to 31st Dec 2012. Six hundred cases undergoing elective LSCS were selected for randomized trial. Clinical observations were made after placental expulsion for scoring which includes shape and size of uterus, rugosity, tone, placental localization and time of placental expulsion. Scores of 0, 1, 2 were given on each observation. Three groups are created depending on scoring: group A (n = 300)—8 to 10, group B (n = 220)—5 to 7 and group C (n = 80)—&lt;5 for better management. Management protocols were formulated in the three groups for prevention of PPH: group A—oxytocin 10 U (5U IM + 5U IV 30 drops/min in Ringer's lactate 500 ml), group B—oxytocin 15U (5U IM + 10U IV 30 drops/min in Ringer's-lactate 500 ml) + methylergometrine (0.25 mg IM) + anterior posterior uterine wall compression, group C—oxytocin 20 U (5U IM plus 15 U IV 30 drops in ringer lactate 500 ml) + methylergometrine (0.5 mg IM) + carboprost (250 mcg IM) + lateral followed by anterior posterior uterine wall compression + isthmus compression of uterus + misoprostol 800 mg per rectal during postoperative period. Results After adopting Dutta's score and management protocols, it was interesting to observe that intra and postoperative, blood loss (within 2 hours) were found to be significantly reduced in group A—73.3% (&lt;300 cc), 88% (&lt;200 cc) and group B—63.6% (&lt;300 cc), 81.8% (&lt;200 cc). Intraoperative blood loss &gt;500 cc were also found to be reduce in group A—14.7%, group B—16.3%. In group C, intraoperative blood loss &gt;500 cc were seen in 41.25% and postoperative —37.5% respectively. Hemoglobin level below 11 gm% were found to be not reduced in group A (1.4%), group B (2.6%) and group C (8.7%) after 24 hours of delivery hemodynamic status in all groups were found to be uneventful. Maternal mortality was found to be nil. Conclusion Early diagnosis and management of uterine atony during elective LSCS after adopting Dutta's score were found to be not only reduce intra- and postoperative blood loss but also was found to maintain a satisfactory hemoglobin level and hemodynamic status. Maternal mortality was found to be nil. This randomized trial highlighted the importance of prompt treatment in group C to reduce intra- and postoperative blood loss and maternal mobidity and mortality. How to cite this article Dutta DK, Dutta I. Uterine Atony: An Innovative Dutta's Scoring System for Elective Cesarean Section. J South Asian Feder Obst Gynae 2015;7(3):113-117.

Cronificación del dolor tras episiotomía

ObjectiveTo analyze the incidence of chronic pain 5 months after episiotomy, as well as potential prognostic factors. MethodsA prospective cohort observational study was conducted on pregnant women age≥18 years who had undergone an episiotomy. The presence of pain was evaluated in the area of episiotomy at 24 and 48h of delivery using a structured face-to-face questionnaire, and by telephone questionnaire at 5 months. The primary endpoint was the presence of persistent pain at 5 months. A record was made of the presence of pain at delivery, and its intensity, the presence or absence of epidural analgesia, instrumental delivery, perineal tear, and pain when episiotomy was performed, as well as the presence of dyspareunia and urinary incontinence at 5 months post-episiotomy. ResultsA total of 87 parturient patients were included, of whom 78 completed the study. Of the patients who completed the study, 12.8% reported chronic episiotomy pain. Epidural analgesia was associated with a higher incidence of instrumental delivery and less pain at the time of episiotomy and expulsion (P<.0005, P<.02, and P<.01, respectively). Chronic pain is associated with operative delivery (P<.017), and with the presence of pain at rest at 24 and 48h (P<.01), of wound complications (P<.026), and of dyspareunia (P<.001). ConclusionAn incidence of 12.8% of women developing chronic pain after delivery with episiotomy suggests a health problem. More studies are needed to confirm our results.

UMA SÓ ORDEM RELIGIOSA, DUAS COROAS: OS COLÉGIOS DA COMPANHIA DE JESUS DO RIO DE JANEIRO E DE CÓRDOBA (SÉCULOS XVI-XVIII)

Neste artigo, reconstituímos, inicialmente, as origens e as funções desempenhadas por dois colégios da Companhia de Jesus na América: o do Rio de Janeiro e o de Córdoba –, destacando, especialmente, sua importância enquanto centros de formação e de dispersão do projeto missionário por meio dos inventários produzidos nos momentos de expulsão da ordem em 1759 (América portuguesa) e em 1767 (América hispânica). Os acervos de suas bibliotecas e boticas constatam que eram centros de difusão e produção de conhecimentos, assim como, suas fazendas e haciendas demonstram a importância econômica para a sustentação do projeto missionário. A despeito de estes colégios terem sido instalados em regiões sob a administração de soberanos rivais e em conjunturas bastante distintas – separadas por mais de cinquenta anos –, as motivações para sua criação foram as mesmas, assim como as funções que lhes foram atribuídas e que vieram a desempenhar

Role of tamsulosin, tadalafil, and silodosin as the medical expulsive therapy in lower ureteric stone: a randomized trial (a pilot study).

To evaluate the role of 2 different α-1 blockers and 1 phosphodiesterase-5 inhibitor as medical expulsive therapy for distal ureteric calculi. Between January 2011 and December 2012, 285 patients presenting with distal ureteric stones of size 5-10 mm were on consent randomly assigned to 1 of 3 outpatient treatment arms: tamsulosin (group A), silodosin (group B), and tadalafil (group C). Therapy was given for a maximum of 4 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of hospital visits for pain, follow-up, and endoscopic treatment and adverse effects of drugs were noted. All 3 groups were compared for normally distributed data by the analysis of variance, Bonferroni or Kruskal-Wallis test, and Mann-Whitney U test, as required. All the classified and categorical data were analyzed for all 3 groups by using the chi-square test. There was a statistically significant expulsion rate of 83.3% in group B compared with 64.4% and 66.7% in groups A and C, respectively, with lower time of stone expulsion (P value = .006 and P value = .016, respectively). Statistically significant differences were noted in colicky episodes and analgesic requirement in group B than groups A and C. There was no serious adverse event. Medical expulsive therapy for the distal ureteric stones using tamsulosin, silodosin, and tadalafil is safe, efficacious, and well tolerated. The result of this pilot study showed that silodosin increases ureteric stone expulsion quite significantly along with better control of pain with significantly lesser analgesic requirement.