Regions Of Pelvis Research Articles

How can we measure the renal pelvic anteroposterior diameter in postnatal isolated hydronephrosis?

The anteroposterior diameter (APD) of the renal pelvis is a commonly used ultrasound parameter in the evaluation and management of hydronephrosis. It has been established that an APD value associated with pyeloplasty is around 25mm. Some believe the APD should be measured at the innermost part of the renal pelvis while others suggest that it should be done at the renal contour. However, there is no consensus on the optimal APD measurement technique including whether it should be measured supine or prone. This study compared six different techniques of APD measurements, in both supine and prone positions, and further evaluated their association with pyeloplasty. Data was obtained by retrospectively reviewing patients' charts that had initial high-grade hydronephrosis (HGH) from 2008 to 2014. We recorded the patients' demographics, ultrasound data and management choice. In the mid-renal transverse plane, the APD was measured by 2 blinded investigators, at the intra-renal, renal contour and extra-renal regions of the renal pelvis in supine and prone positions (FigureA). We compared the six APD measurements based on the outcome of management (pyeloplasty vs. conservative management). The ROC curve obtained was then used to assess the ability of various APD measurements in predicting surgical intervention. The cutoff value chosen that predicts pyeloplasty was the lowest diameter with 100% specificity. We included 129 patients (134 renal units). Forty-four renal units (42 patients) underwent pyeloplasty whereas 90 renal units (87 patients) were managed conservatively. Patients' demographics were grouped by both SFU grade and clinical outcome. Regardless of grade, the APD measurements were different in all 6 techniques. All APD measurement techniques showed good inter-rater reliability. Based on the ROC curve, all APD measurements were associated with pyeloplasty with an AUC from 0.89 to 0.91. The supine extra-renal APD measurement of 24mm was the most sensitive cutoff value. The cutoff values ranged from 18 to 27mm when including patients from all grades of hydronephrosis. The median APD measurements were significantly less for SFU grade 3 than grade 4 hydronephrosis in all positions (P<0.001 for all measurements), yet the predictive cutoff value of 24mm for the supine extra-renal was similar for both grades. APD measurements differ based on the technique, but they are all equally associated with the clinical outcome of pyeloplasty. The inter-rater reliability of all techniques were excellent. Though the median APD measurements are smaller in SFU grade 3, it appears that the cutoff for a predictive renal pelvic APD does not differ between SFU grades 3 and 4 for the supine extra-renal technique. We conclude that the technique for measuring the APD needs to be specified in studies of hydronephrosis and in any grading systems.

Quantification and visualization of anterior pelvis bone density to optimize screw fixation: A novel technique.

Plate fixation of anterior pelvic ring fractures is often a vital component when surgically treating unstable pelvis fractures. Certain plate and screw configurations can have premature implant loosening, potentially in part due to insufficient pullout strength in lower density bone. This study sought to define densities about the anterior pelvic ring using a novel computer-based technique. Thirty-three patients who received a computed tomography (CT) of the abdomen/pelvis for reasons other than pelvis fracture in a 1-month time period were included. Three statistically distinct density regions of the anterior pelvis were identified based on the three-dimensional (3D) density map. The densest regions included both the anterior and posterior aspects of the superior pubic ramus, along with the region of bone along the inferior cotyloid fossa. The intermediate density region included the caudal and medial pubic body. The least dense region included the anterior aspect of the inferior pubic ramus (IPR), the posterior pubic body, and the posterior/inferior IPR. This study presents specific quantification of anterior pelvis bone density based on a novel technique using opportunistic CT scans. Clinical Significance: Anterior surgical fixation of unstable pelvic ring injuries may benefit from targeting areas of higher density as described in this novel technique.

Introducing the New Surgical Robot HUGO™ RAS: System Description and Docking Settings for Gynecological Surgery.

This study provides a detailed description of the new HUGO™ RAS System and suggests docking settings for gynecological surgery. The system is composed of an “open” surgical console with an HD–3D passive display, a system tower, and four arm carts. Each arm has an extremely wide range of adaptability resulting from the numerous joints. The human cadaver labs were performed at the ORSI Academy between August and December 2021. All procedures were performed by two surgical teams, each composed of a high-volume surgeon experienced in robotic surgery, gynecologic oncology, and pelvic sidewall surgery, and one bedside assistant. Three main gynecological surgical scenarios were identified: standard pelvic surgery, pelvic sidewall surgery, and para-aortic/upper abdominal surgery. Concerning the port placement, the chosen options were called “straight” and “bridge”; instead, the so-called “compact” and “butterfly” configurations were identified for the arm cart positioning. Four cadavers were used to perform total hysterectomy, radical hysterectomy, pelvic exenteration, pelvic and para-aortic lymphadenectomy, and omentectomy. We performed several tests, identifying the best system configurations to draw the proper efficiency from the flexibility of the system in all gynecological surgical scenarios. The straight port placement seems to be adequate for standard pelvic surgery. The bridge trocar position is best to reach the deeper and lateral anatomical regions of the female pelvis. The compact and butterfly arm cart allocations are adequate for both straight and bridge port placement. When deep pelvic surgery was performed, the bedside assistant became more proficient by working with a standard laparoscopic instrument from an ancillary port placed in the left iliac fossa. The arm carts needed to be moved in an open manner, like for the proposed butterfly configuration. On the contrary, the compact disposition left enough space to assist from Palmer’s point port. Several basic and advanced gynecological surgical procedures were performed and completed successfully without encountering any technical or surgical issue, the results obtained were judged sufficient to proceed with the clinical experience in daily practice. The HUGO™ RAS system is flexible and highly performative in various surgical scenarios.

Isolating and Imaging Live, Intact Pacemaker Regions of Mouse Renal Pelvis by Vibratome Sectioning.

The renal pelvis (RP) is a funnel-shaped, smooth muscle structure that facilitates normal urine transport from the kidney to the ureter by regular, propulsive contractions. Regular RP contractions rely on pacemaker activity, which originates from the most proximal region of the RP at the pelvis-kidney junction (PKJ). Due to the difficulty in accessing and preserving intact preparations of the PKJ, most investigations on RP pacemaking have focused on single-cell electrophysiology and Ca2+ imaging experiments. Although important revelations on RP pacemaking have emerged from such work, these experiments have several intrinsic limitations, including the inability to accurately determine cellular identity in mixed suspensions and the lack of in situ imaging of RP pacemaker activity. These factors have resulted in a limited understanding of the mechanisms that underlie normal rhythmic RP contractions. In this paper, a protocol is described to prepare intact segments of mouse PKJ using a vibratome sectioning technique. By combining this approach with mice expressing cell-specific reporters and genetically encoded Ca2+ indicators, investigators may be able to more accurately study the specific cell types and mechanisms responsible for peristaltic RP contractions that are vital for normal urine transport.

Isolating and Imaging Live, Intact Pacemaker Regions of Mouse Renal Pelvis by Vibratome Sectioning

Isolating and Imaging Live, Intact Pacemaker Regions of Mouse Renal Pelvis by Vibratome Sectioning

Spatial mapping of functional pelvic bone marrow using FLT PET

The purpose of this study was to determine the ability of regions identified with bony landmarks on CT imaging to accurately represent active bone marrow when compared to FLT PET imaging. These surrogate regions could then be used to create a bone marrow sparing radiation therapy plan when FLT PET imaging is not available. Whole body (WB) FLT PET images were obtained of 18 subjects prior to chemoradiation therapy. The FLT image of each subject was registered to a CT image acquired for that subject to obtain anatomic information of the pelvis. Seventeen regions were identified based on features of the pelvic bones, sacrum, and femoral heads. The probability of FLT uptake being located in each of 17 different CT‐based regions of the bony pelvis was calculated using Tukey's multiple comparison test. Statistical analysis of FLT uptake in the pelvis indicated four distinct groups within the 17 regions that had similar levels of activity. Regions located in the central part of the pelvis, including the superior part of the sacrum, the inner halves of the iliac crests, and the L5 vertebral body, had greater FLT uptake than those in the peripheral regions (p‐value < 0.05). We have developed a method to use CT‐defined pelvic bone regions to represent FLT PET‐identified functional bone marrow. Individual regions that have a statistically significant probability of containing functional bone marrow can be used as avoidance regions to reduce radiation dose to functional bone marrow in radiation therapy planning. However, because likely active bone marrow regions and pelvic targets typically overlap, patient‐specific spatial detail may be advantageous in IMRT planning scenarios and may best be provided using FLT PET imaging.PACS number: 87.57.uk

Quantitative assessment of microcirculation and diffusion in the bone marrow of osteoporotic rats using VCT, DCE-MRI, DW-MRI, and histology

Etiologic and pathophysiologic role of functional bone marrow processes is not fully understood especially in the case of osteoporosis. To investigate the role of vascularization and diffusion in rat models of osteoporosis through a cross-correlation between non-invasive in-vivo imaging and invasive ex-vivo imaging of bone, bone marrow, and in particular of microcirculation. Osteoporosis was induced in rats by combining ovariectomy (OVX) with calcium and Vitamin D3 deficiency, or with glucocorticoid (dexamethasone). For comparison, controls underwent a sham surgery. In in-vivo investigations, animals (n = 36) were examined by volumetric CT (VCT) and MRI at 1, 3, or 12 months post surgery. Using VCT, bone morphology was monitored and relative bone density r within pelvis was extracted. With DCE-MRI and DW-MRI, parameters A (amplitude), Kep (exchange rate constant), and ADC (apparent diffusion coefficient) were acquired for regions of lumbar vertebrae, pelvis, and femur. In ex-vivo investigations, selective histological sections of pelvis were either stained with hematoxylin and eosin (HE stain) for quantifying vessel size and density or immunostained for collagen IV and α-smooth muscle actin to assess vessel maturity (SMA/collagen IV ratio). After 12 months, decrease in DCE-MRI parameter Kep was found in all locations of osteoporotic rats (strongest in femur and lumbar vertebrae) while no significant differences were seen for parameter A and DW-MRI parameter ADC. Furthermore, vessel rarefication and maturation were observed on the histological level in animals with osteoporotic phenotype. In particular in the pelvis, the osteoporotic individuals (irrespective of the osteoporosis inducers applied) exhibited decreased Kep, significantly reduced vessel density, significantly increased vessel maturity, as well as statistically unaltered A, ADC, and vessel diameter. Changes in microcirculation but not diffusion in the bone marrow of osteoporotic rats are detected by DCE-MRI and DW-MRI due to vessel rarefication and maturation.

Spontaneous electrical and Ca2+ signals in typical and atypical smooth muscle cells and interstitial cell of Cajal‐like cells of mouse renal pelvis

Electrical rhythmicity in the renal pelvis provides the fundamental drive for the peristaltic contractions that propel urine from the kidney to bladder for storage until micturition. Although atypical smooth muscles (ASMCs) within the most proximal regions of the renal pelvis have long been implicated as the pacemaker cells, the presence of a sparsely distributed population of rhythmically active Kit-positive interstitial cells of Cajal-like cells (ICC-LCs) have confounded our understanding of pelviureteric peristalsis. We have recorded the electrical activity and separately visualized changes in intracellular Ca(2+) concentration in typical smooth muscle cells (TSMCs), ASMCs and ICC-LCs using intracellular microelectrodes and a fluorescent Ca(2+) indicator, fluo-4. Nifedipine (1-10 microm)-sensitive driven action potentials and Ca(2+) waves (frequency 6-15 min(-1)) propagated through the TSMC layer at a velocity of 1-2 mm s(-1). High frequency (10-40 min(-1)) Ca(2+) transients and spontaneous transient depolarizations (STDs) were recorded in ASMCs in the absence or presence of 1 microm nifedipine. ICC-LCs displayed low frequency (1-3 min(-1)) Ca(2+) transients which we speculated arose from cells that displayed action potentials with long plateaus (2-5 s). Neither electrical activity propagated over distances > 50 microm. In 1 microm nifedipine, ASMCs or ICC-LCs separated by < 30 microm displayed some synchronicity in their Ca(2+) transient discharge suggesting that they may well be acting as 'point sources' of excitation to the TSMC layer. We speculate that ASMCs act as the primary pacemaker in the renal pelvis while ICC-LCs play a supportive role, but can take over pacemaking in the absence of the proximal pacemaker drive.

Vergleichende biomechanische Untersuchung zur internen Stabilisierung der transforaminalen Sakrumfraktur

Reliable osteosynthesis for fractures in the different regions of the human pelvis are described in the literature while there is no common and satisfying treatment for unstable sacral fractures. Because of the posterior pelvic rings special anatomic conditions a local plate osteosynthesis seems to be advantageous. In many fields of modern fracture treatment locking implants show superior results. The prototype of a local locking plate osteosynthesis was compared to a common local plate and two sacroiliac screws. The implants were tested using six plastic models of the pelvis and three embalmed human specimens. A Tile C1 fracture was created by disruption of the pubic symphysis and a transforaminal osteotomy. The specimens were exposed to axial loading in an upright single-leg stance with a maximum of 800 N for the plastic models and 200 N for the human specimens. An ultrasonic-based measuring system recorded translations (X, Y, Z) and rotations (alpha, beta, gamma). Parameters such as pattern of motion, translation/rotation, load to failure and remaining dislocation were evaluated. Concerning most of the evaluated parameters the local plate osteosynthesis was inferior compared with two sacroiliac screws. There were no significant differences between the locking implant and the local plate osteosynthesis. Compared with the two sacroiliac screws the locking implant shows biomechanically equal results but allows greater anterior rotation and remaining dislocation. Because of the lower bone quality, the results from the anatomic specimen tested were not utilisable. The locking implant is biomechanically an alternative compared with two sacroiliac screws. Problems occurred due to the preset direction of the locking head screws.

Pelviureteric peristaltic contractions in diabetic rats

The effects of strepozotocin (STZ)-induced diabetes on the spontaneous peristaltic contractions in the upper urinary tract (UUT) of the rat were examined by simultaneously recording the tension in the proximal and distal regions of the renal pelvis and the proximal ureter. All regions of the UUT of diabetic rats contracted at a frequency similar to the contraction frequency of age-matched control rats. In contrast, contraction amplitudes in the proximal and distal renal pelvis and ureter of diabetic rats were 36%, 135% and 121% larger than the equivalent contractions recorded in control rats resulting in a significant increases in the motility index (MI amplitude x frequency) in all 3 regions. Capsaicin (10 microM), substance P (SP 2 microM) and neurokinin A (NKA 2 microM) caused a transient increase in MI in both control and STZ-induced diabetic rats. The rise in basal tension in the proximal and distal renal pelvis evoked by capsaicin, SP or NKA was also significantly greater in the diabetic rats when compared with controls. In contrast, human calcitonin-gene related peptide (hCGRP) produced a relatively small transient inhibition of UUT motility which was little affected by STZ treatment. These results suggest that capsaicin predominantly releases tachykinins from intrinsic sensory nerves in both non-diabetic and STZ-induced diabetic rats. We speculate that the supersensitivity of the diabetic UUT to capsaicin, NKA and SP 8-10 weeks after STZ treatment could be arising from an earlier development of sensory neuropathy.

Pyeloureteric peristalsis: role of atypical smooth muscle cells and interstitial cells of Cajal‐like cells as pacemakers

Pyeloureteric peristalsis has long been considered to be triggered by pacemaker atypical smooth muscle cells (SMC) located in the proximal regions of the renal pelvis. However, interstitial cells with many of the morphological features and c-Kit immuno-reactivity of interstitial cells of Cajal (ICC), the established pacemaker cells in the intestine, have been demonstrated to be present in small numbers within the ureteropelvic junction (UPJ) of many mammals. Freshly isolated ICC-like cells (ICC-LC) of the mouse UPJ also display autorhyhmicity. This review discusses the notion that ureteric peristalsis depends on the presence of both atypical SMC and ICC-LC which form separate but interconnected networks that drive electrically quiescent typical SMC. In contrast to the intestine or prostate, all regenerative potential discharge in the mouse UPJ is abolished by the L-type Ca(2+) channel blocker nifedipine revealing a fundamental pacemaker signal. Whether these pacemaker transients arise from atypical SMC or ICC-LC or both has yet to be established. We speculate that the presence of spontaneously active ICC-LC in the distal regions of the UPJ maintains rudimentary peristaltic waves and movement of urine towards the bladder after pyeloureteral obstruction or pyeloplasty and disconnection from the proximal pacemaker drive.

Pyeloureteral motility and ureteral peristalsis: essential role of sensory nerves and endogenous prostaglandins.

The cellular mechanisms that underlie the initiation and propagation of the peristaltic contractions, which transport urine from the kidney to the bladder for storage, remain little understood. Extracellular and intracellular microelectrode recordings have identified two populations of smooth muscle cells as well as a population of renal interstitial cells (RICs) that all display spontaneous electrical activity. By analogy with the heart it has been proposed that atypical smooth muscle cells, preferentially located in the very proximal regions of the renal pelvis, generate the essential pacemaker signal. These pacemaker potentials propagate to neighbouring typical smooth muscle cells or RICs to trigger action potential discharge. These action potentials then propagate distally to trigger other bundles of typical smooth muscle cells. The frequency of action potential discharge and contraction decreases as the relative number of RICs and atypical smooth muscle cells compared to typical smooth muscle cells decreases with distance from the renal fornix. It is clear that functional capsaicin-sensitive sensory afferents and the endogenous release of both tachykinins and prostaglandins are essential in the maintenance of normal peristalsis, as well as in monitoring and responding to any chemical or mechanical stimulation. However, the cellular mechanisms underlying the action of these endogenously-released agents remain to be elucidated.

Developmental changes in the biochemical and functional properties of endothelin receptors in rabbit renal pelvis.

To examine the effect of age on the biochemical and functional properties, and regional distribution of endothelin (ET) receptors in the rabbit renal pelvis. The properties of ET receptors in 6-week-old and 6-month-old male rabbit renal pelves were examined using isolated muscle-bath and radioligand receptor-binding techniques. ET-1 caused a significant increase in the contractile force in muscle strips from all regions of the renal pelvis from both age groups, with the following rank order: upper=middle>lower. The magnitude of the ET-1-induced contractile responses were similar in the lower pelvic regions in both ages, but the responses in the upper and middle regions were significantly greater in younger rabbits. ET-1 increased the frequency of spontaneous activity in a concentration-dependent manner in the upper and middle pelvic regions in both age groups, with significantly smaller ED50 values in the younger than in the older rabbits. In both age groups the lower pelvic region lacked spontaneous activity. The density of total ET receptors was higher in the upper and middle regions of the renal pelvis than in the lower renal pelvis of both ages, with the density in the upper and middle regions being greater in older than in younger rabbits. In all regions, ET subtype selective compounds inhibited [125I]ET-1, binding consistent with the predominance of the ETA receptor subtype, except in the lower region of the older rabbits, in which the densities of ETA and ETB subtypes were similar. In all regions, the younger renal pelvis contained a higher proportion of ETA receptors than in older tissues. Light microscopic autoradiographic data indicated the presence of ETA and ETB receptors in smooth muscle and epithelial cells, respectively. These data indicate the presence of regional differences in the density of ET receptors and in the contractile responses to ET-1 in rabbit renal pelvis, and that although older rabbit renal pelvis contains more total ET receptors than younger renal pelvis, the latter had a higher portion of the ETA receptor subtype and the younger tissues were more responsive to ET-1.

Electrical basis of peristalsis in the mammalian upper urinary tract.

1. Peristalsis in the mammalian upper urinary tract (UUT) is mostly myogenic in origin, originating predominately in the proximal pelvicalyceal regions of the renal pelvis, an area that is enriched with specialized smooth muscle cells termed 'atypical' smooth muscle cells. Propagating peristaltic contractions are little affected by blockers of either autonomic nerve function or nerve impulse propagation; however, blockers of sensory nerve function or prostaglandin synthesis reduce both the frequency and the strength of the spontaneous contractions underlying peristalsis. 2. The electrical drive for these peristaltic contractions has long been considered to involve mechanisms analogous to the heart, such that 'atypical' smooth muscle cells generate spontaneous 'pacemaker' action potentials. These pacemaker potentials trigger the firing of action potentials and contraction in the muscular regions of the renal pelvis, which propagate distally to the ureter, propelling urine towards the bladder. 3. Recent intracellular microelectrode and single cell/channel patch-clamp studies have revealed that the ionic conductances underlying the action potentials recorded in the UUT are likely to involve the opening and slow closure of voltage-activated 'L-type' Ca2+ channels, offset by the time-dependent opening and closure of both voltage- and Ca(2+)-activated K+ channels. 4. In the present review we summarize the current knowledge of the ionic mechanisms underlying action potential discharge in the UUT, as well as present our view on how this electrical activity supports the initiation and conduction of UUT peristalsis.

Pharmacological modulation of electromechanical coupling in the proximal and distal regions of the guinea-pig renal pelvis.

1. The effect of drugs affecting calcium and potassium channels and intracellular calcium handling/release on electromechanical coupling in the smooth muscle of the guinea-pig proximal vs. distal renal pelvis were investigated by using the single sucrose gap method. 2. Spontaneous action potentials discharged from the proximal renal pelvis were bell-shaped, did not show a pronounced plateau and had a small after-hyperpolarization. Spontaneous action potentials from the distal renal pelvis were characterized by a fast depolarization, a pronounced plateau and after-hyperpolarization. 3. Nifedipine (1 microM) suppressed action potentials in both regions of the renal pelvis. A submaximally effective concentration of nifedipine (50 nM) shortened action potential duration and reduced contractility in both regions of the renal pelvis. On the other hand Bay K 8644 (1 microM) markedly prolonged the duration of the action potential and increased contractility in both regions of the renal pelvis. 4. Tetraethylammonium (0.5 mM) markedly prolonged the action potential duration and contraction in the distal renal pelvis without affecting action potentials in the proximal renal pelvis. Similar effects were produced by a slightly higher concentration of tetraethylammonium (2 mM) in the proximal renal pelvis. 5. Charybdotoxin (30 nM) markedly prolonged the duration of action potential and increased and prolonged the contraction in both the proximal and distal renal pelvis. 6. 4-aminopyridine (1 mM) selectively increased the frequency of action potentials in the distal renal pelvis without affecting other parameters of the action potential nor contractility. 4-aminopyridine had no effect in the proximal renal pelvis. 7. The inhibitor of sarcoplasmic reticulum Ca-ATPase, cyclopiazonic acid (10 microM) transiently increased the frequency of action potentials in both regions of the renal pelvis; CPA markedly delayed the repolarizing phase of the action potential in both the proximal and distal renal pelvis and, in parallel, increased contractility. 8. We conclude that action potentials generated from the proximal and distal regions of the guinea-pig renal pelvis are evenly dependent upon the availability of L-type Ca channels; that Ca-dependent maxi K channels provide a major contribution to the repolarization of action potentials in both regions of the renal pelvis, thus regulating duration/intensity of Ca influx and contraction; that release of Ca from the internal store is not important in providing activator Ca for contraction but regulates duration of the action potential and may be involved in setting the frequency of discharge of pacemaker cells.

CGRP inhibition of electromechanical coupling in the guinea-pig isolated renal pelvis.

We aimed at studying the mechanism(s) of the inhibitory effect exerted by calcitonin gene-related peptide (CGRP) on the spontaneous activity of the guinea-pig isolated renal pelvis. In organ bath experiments, CGRP (1-100 nM) produced a concentration-dependent (EC50 8 nM) partial inhibition (Emax about 35% inhibition of motility index) of spontaneous contractions. The potassium (K) channel opener, cromakalim (3-10 microM) promptly suppressed the spontaneous contractions in a glibenclamide-(10 microM) sensitive manner. Glibenclamide (10 microM) did not affect the inhibitory action of CGRP. The calcium (Ca) channel agonist, Bay K 8644 (1 microM), markedly enhanced the spontaneous activity of the renal pelvis and reduced the inhibitory effect of CGRP. The protein kinase A inhibitors Rp-cAMPS (300 microM), H8 (100 microM) and H89 (10 microM), and the blockers of intracellular Ca handling by sarcoplasmic reticulum, ryanodine (100 microM) and thapsigargin (1 microM) did not affect the response to CGRP. The response to CGRP was likewise unaffected by the nitric oxide synthase inhibitor, L-nitroarginine (30 microM) and by the protein kinase G inhibitor, KT5823 (3 microM). Furthermore, the inhibitory action of CGRP was not modified by lowering the extracellular concentration of K (from 5.9 to 1.2 mM) nor by increasing (from 2.5 to 3.75 mM) or decreasing (from 2.5 to 0.25 mM) the extracellular Ca concentration. Replacement of 80% glucose with 2-deoxyglucose (2-DOG) reduced the amplitude of spontaneous contractions, both in the absence and presence of 10 microM glibenclamide. In the presence of 2-DOG, the inhibitory action of CGRP was enhanced at a similar extent, either in the absence or presence of glibenclamide. In sucrose gap, the effect of CGRP (0.1 microM for 5 min) was separately analyzed in the proximal (close to the kidney) and distal (close to the ureter) regions of the renal pelvis. Both preparations discharged spontaneous (pacemaker) action potentials having different shape, duration and frequently. CGRP had no effect on pacemaker potentials in the proximal renal pelvis while producing about 30% reduction of the frequency of pacemaker potentials and motility index in the distal renal pelvis. Cromakalim (3 microM) abolished pacemaker potentials in both regions of the renal pelvis. In conjunction with the results of previous studies in the guinea-pig ureter, the present findings document the existence of remarkable regional differences in the effector mechanisms initiated by CGRP receptor occupancy in the guinea-pig pyeloureteral tract. CGRP appears to be inherently unable to activate glibenclamide-sensitive K channels in the guinea-pig renal pelvis, a mechanism which is central for its ability to suppress latent pacemakers in the ureter. Within the renal pelvis, the sensitivity to the inhibitory effect of CGRP appears in the more distal region, from which an 'ureter-like' action potential is recorded.

Surgical indications for Ewing's sarcoma of the pelvis

Despite advances in adjuvant therapy, Ewing's sarcoma of the pelvis remains an anatomic site with a poor prognosis. This study evaluate the role of surgery in the management of patients with pelvic Ewing's sarcoma who also received conventional radiation therapy and chemotherapy. From May 1978 to February 1994, 19 patients with Stage IIB Ewing's sarcoma of the pelvis were treated at the UCLA Medical Center (Los Angeles, CA). There were eight lesions of the ilium, two of the sacrum, and nine involving two adjoining regions of pelvis. All patients received conventional medical management. The 19 patients were divided into two groups according to treatment modality. A group of 12 patients (Group A) had surgical resection, and their results were compared with those of another group of 7 patients (Group B) who did not have surgery. The 5-year cumulative survival (Kaplan-Meier method) was 39% for all patients, 51% for Group A, and 18% for Group B. The 3-year cumulative survival was 59% for all patients, 72% for Group A, and 36% for Group B. Although the survival rate of Group A seemed better than that of Group B, the difference was not statistically significant (P = 0.093, log rank method). This study also suggested that, regardless of treatment modality, the outcome of patients with lesions involving two adjoining pelvic bones was poorer than that of those with a single lesion. In Group A, the 3-year cumulative survival rate for patients with single bone lesions (n = 8) was 86% and for patients with lesions involving two adjoining pelvic bones (n = 4) was 50% (P = 0.045, log rank method). Furthermore, the statistical analysis of the combined data of the single pelvic bone lesions in UCLA and that of Mayo Clinic series (n = 16 for surgery group and n = 15 for nonsurgery group) confirmed the better results for the surgical patients, which was consistent with the results from the Mayo Clinic with an even greater significance (P < 0.002). This study demonstrates that surgery plus chemotherapy and radiation therapy is helpful for treating patients with pelvic Ewing's sarcoma so long as the tumor is limited to a single pelvic bone.

Effects of intrinsic prostaglandins on the spontaneous contractile and electrical activity of the proximal renal pelvis of the guinea‐pig

1. The effects of blocking prostaglandin biosynthesis with indomethacin on the spontaneous electrical and contractile activity recorded in smooth muscle strips of the guinea-pig renal pelvis were examined using standard tension and membrane potential recording techniques. 2. Circumferentially cut strips of proximal renal pelvis contracted more frequently (4.5 +/- 0.2 min-1) than strips cut from the mid region (1.3 +/- 0.2; P < 0.05, n = 5) of the renal pelvis. 3. Indomethacin (1 nM-10 microM) reduced the amplitude and frequency of the contractions of the renal pelvis in a concentration- and time-dependent manner. Contractions were completely abolished in the presence of 30 microM indomethacin. 4. After indomethacin blockade, activation of prostaglandin F2 alpha (PGF2 alpha) receptors with dinoprost (1-100 nM) restored the amplitude and frequency of the spontaneous contractions of renal pelvis. Higher concentrations of dinoprost (> 100 nM-3 microM) increased the contraction amplitude of the proximal and mid renal pelvis 1.9 and 1.6 times respectively. The contraction frequency of the mid renal pelvis, but not the proximal pelvis, was also raised above its pre-indomethacin frequency. 5. The spontaneous electrical activity recorded in proximal strips of the renal pelvis was designated to come from three cell types: (i), pacemaker cells (10% of cells recorded), with simple action potentials comprising relatively slow rising and repolarizing phases triggered on top of a slowly-developing pre-potential; (ii), driven cells (75% of cells), with complex action potentials comprising a rapid initial spike, followed by a period of membrane oscillation and a plateau of 0.2-2 s duration; and (iii), intermediate cells (15%) which fired action potentials with an initial rapid and a long plateau phase. 6. Indomethacin (10-30 micro M) decreased the amplitude and frequency of the action potentials recorded in driven and intermediate cells. The membrane potential of these cells also depolarized 5mV to-51.2 +/-2.6mV (n=5).7. Dinoprost (300 nM-1.5 micro M) increased the rate of action potential discharge, without affecting the membrane potential of driven cells previously exposed to indomethacin (30 micro M).8. These data suggest that the endogenous release of prostaglandins is necessary for the in vitro spontaneous contractile activity recorded in the guinea-pig renal pelvis. Blockade of the synthesis of these prostaglandins appears either to modify the ability of the driven regions of the renal pelvis to fire action potentials or to reduce the coupling of these driven regions to their pacemaker cells.

The Characterization of Beta-Adrenergic Receptor Subtypes of the Upper and Lower Renal Pelvis in Rabbits

We characterized the beta-adrenergic receptors in the upper (pacemaker) and lower (nonpacemaker) regions of the rabbit renal pelvis, using radioligand binding techniques. [3H]Dihydroal-prenolol was the ligand used for determining the total density of beta-adrenergic receptors. The beta-1 and beta-2 subtypes of beta-adrenergic receptors were defined by inhibition of [3H]DHA binding by ICI 89,406, a beta-1 selective antagonist, and ICI 118,551, a beta-2 selective antagonist. Saturation studies with [3H]DHA showed that there was no significant difference in the equilibrium dissociation constant, KD, and the maximum number of binding sites Bmax, between the upper and lower renal pelvis. Although the inhibition constants of ICI 118,551 were smaller than those of ICI 89,406 in both the upper and lower pelvis, indicating a predominance of beta-2 receptors in both regions, the Ki values of ICI 118,551 were significantly greater in the upper than in lower pelvis. These data suggest that there are significant amounts of beta-adrenergic receptors in the rabbit renal pelvis without regional differences in the total density of beta receptors and that there is a greater proportion of beta-2 subtypes in the lower than in the upper renal pelvis.

Conduction velocity in various regions of the renal pelvis and ureter.

Conduction velocity of excitation in various regions of the canine pelviureter was studied through the simultaneous recordings of electromyograms at four sites of the canine pelvicalyceal preparation. The pelviureteral system was maintained in the condition which was similar to in vivo situation by infusion of oxygenated Krebs-Ringer solution into the renal pelvis at the average flow rate of living dogs. The conduction velocity was slowest in the proximal region of the pelvis where the pacemaker was located, i.e., about 5.8 mm/sec on an average. The velocity gradually increased in the distal region of the pelvis and the ureter. It was suggested that the conduction velocity of excitation was significantly different in the proximal area of the pelvis, the distal area of the pelvis and the ureter.