Neurovascular Alterations Research Articles

2164 MEASUREMENT OF DETRUSOR TISSUE SATURATION INDEX (TSI) AND COMPARISON OF DETRUSOR OXYGENATION DURING URODYNAMICS TO NATURAL FILLING/EMPTYING USING WIRELESS NEAR-INFRARED SPECTROSCOPY IN THE NEUROGENIC BLADDER

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Urodynamic Testing1 Apr 20112164 MEASUREMENT OF DETRUSOR TISSUE SATURATION INDEX (TSI) AND COMPARISON OF DETRUSOR OXYGENATION DURING URODYNAMICS TO NATURAL FILLING/EMPTYING USING WIRELESS NEAR-INFRARED SPECTROSCOPY IN THE NEUROGENIC BLADDER Andrew Macnab, Lynn Stothers, Babak Shadgan, and Mark Nigro Andrew MacnabAndrew Macnab Vancouver, Canada More articles by this author , Lynn StothersLynn Stothers Vancouver, Canada More articles by this author , Babak ShadganBabak Shadgan Vancouver, Canada More articles by this author , and Mark NigroMark Nigro Vancouver, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2401AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Near-Infrared spectroscopy has been used to measure changes in detrusor oxygenated, deoxygenated and total hemoglobin concentration (O2Hb, HHb & tHb) during filling and voluntary voiding in non neurogenic subjects. The tissue saturation index (TSI) provides a value of oxygenation independent of a tissue path length factor unique to the NIRS technique. The objective of this study was to observe: (1) changes in wireless NIRS chromophores during artificial filling with UDS(2) to provide within patient comparisons during natural filling/reflex voiding and (3) to measure the detrusor TSI in neurogenic bladders. METHODS NIRS was recorded using wavelengths of 760, 850 and 830 nanometers. Data was held internally in a NIRS wireless instrument (Artinis Medical Systems ©) and broadcast on demand to a remote computer. NIRS was recorded during natural filling and reflex voiding as well as during multichannel urodynamics with EMG using a water filling at a rate of 50cc. NIRS data (O2Hb, HHb & tHb) were collected at 10 Hz and graphs of patterns of change compared using spatial resolution. Artinis statistical software © calculated continuous TSI in all cases. RESULTS 12 male spinal cord injured (5 ASIA complete and 7 incomplete) T12 or higher, 2 cases of spina bifeda and 3 non neurogenic controls participated. Chromophore tracings were successfully stored in the wireless device and then transmitted in every trial without loss of data allowing a calculated TSI in each case. A wireless tracing in a male neurogenic bladder during filling and reflex voiding is shown with reduced TSI during filling. Spatial resolution found patterns within the same subject reproducible when subjected to overlapping graphic analysis during natural filling/incontinence episodes compared to pump filled UDS.TSI fluctuated during filling in neurogenic cases compared to controls. CONCLUSIONS Wireless NIRS monitoring is feasible in neurogenic non ambulant individuals. NIRS patterns observed during UDS can be reproduced during natural filling. Detrusor TSI was observed to fluctuate during filling in neurogenic individuals providing observation of possible neurovascular alterations in these cases. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byShadgan B, Macnab A and Stothers L (2018) Re: Concordance of Near Infrared Spectroscopy With Pressure Flow Studies in Men With Lower Urinary Tract SymptomsJournal of Urology, VOL. 187, NO. 1, (359-361), Online publication date: 1-Jan-2012. Volume 185Issue 4SApril 2011Page: e866 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Macnab Vancouver, Canada More articles by this author Lynn Stothers Vancouver, Canada More articles by this author Babak Shadgan Vancouver, Canada More articles by this author Mark Nigro Vancouver, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Complex obstetric fistulas

Obstetric fistulas are rarely simple. Most patients in sub-Saharan Africa and parts of Asia are carriers of complex fistulas or complicated fistulas requiring expert skills for evaluation and management. A fistula is predictably complex when it is greater than 4 cm and involves the continence mechanism (the urethra is partially absent, the bladder capacity is reduced, or both); is associated with moderately severe scarring of the trigone and urethrovesical junction; and/or has multiple openings. A fistula is even more complicated when it is more than 6 cm in its largest dimension, particularly when it is associated with severe scarring and the absence of the urethra, and/or when it is combined with a recto-vaginal fistula. The present article reviews the evaluation methods and main surgical techniques used in the management of complex fistulas. The severity of the neurovascular alterations associated with these lesions, as well as inescapable limitations in staff, health facilities, and supplies, make their optimal management very challenging.

Systemic Inflammatory Stimulus Potentiates the Acute Phase and CXC Chemokine Responses to Experimental Stroke and Exacerbates Brain Damage via Interleukin-1- and Neutrophil-Dependent Mechanisms

Systemic inflammatory stimuli, such as infection, increase the risk of stroke and are associated with poorer clinical outcome. The mechanisms underlying the impact of systemic inflammatory stimuli on stroke are not well defined. We investigated the impact of systemic inflammation on experimental stroke and potential mechanisms involved. Focal cerebral ischemia was induced by intraluminal filament occlusion of the middle cerebral artery (MCAo). Brain damage and neurological deficit 24 h after MCAo were exacerbated by systemic lipopolysaccharide (LPS) administration. This exacerbation was critically dependent on interleukin (IL)-1, because coadministration of IL-1 receptor antagonist abolished the effect of LPS on brain damage. Systemic administration of IL-1 increased ischemic damage to a similar extent as LPS and also exacerbated brain edema. IL-1 markedly potentiated circulating levels of the acute phase proteins, serum amyloid A and IL-6, and the neutrophil-selective CXC chemokines, KC and macrophage inflammatory protein-2. Neutrophil mobilization and cortical neutrophil infiltration were aggravated by IL-1 before changes in ischemic damage. Neutropenia abolished the damaging effects of systemic IL-1. These data show for the first time that an acute systemic inflammatory stimulus is detrimental to outcome after experimental stroke and highlight IL-1 as a critical mediator in this paradigm. Our data suggest IL-1-induced potentiation of neutrophil mobilization via CXC chemokine induction is a putative mechanism underlying this effect. Our results may help to explain the poorer outcome in stroke patients presenting with infection and may have implications for neurodegenerative diseases involving neurovascular alterations, such as Alzheimer's disease, in which systemic inflammation can modulate disease progression.