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The clinical practice of anesthesia has undergone many advances in the past few years, making this the perfect time for a new state-of-the-art anesthesia textbook for practitioners and trainees. The goal of this book is to provide a modern, clinically focused textbook giving rapid access to comprehensive, succinct knowledge from experts in the field. All clinical topics of relevance to anesthesiology are organized into 29 sections consisting of more than 180 chapters. The print version contains 166 chapters that cover all of the essential clinical topics, while an additional 17 chapters on subjects of interest to the more advanced practitioner can be freely accessed at www.cambridge.org/vacanti. Newer techniques such as ultrasound nerve blocks, robotic surgery and transesophageal echocardiography are included, and numerous illustrations and tables assist the reader in rapidly assimilating key information. This authoritative text is edited by distinguished Harvard Medical School faculty, with contributors from many of the leading academic anesthesiology departments in the United States and an introduction from Dr S. R. Mallampati. This book is your essential companion when preparing for board review and recertification exams and in your daily clinical practice.

CONTEXT: Urinary bladder and rectum share a common embryological origin. Their autonomic and somatic innervations have close similarities. Moreover, the close proximity of these two organ systems could suggest that dysfunction in one may influence, also mechanically, the function of the other. Therefore, it is not surprising that defecation problems and lower urinary tract symptoms (LUTS) occur together, as reported in the literature. OBJECTIVE: To study the relationship between constipation and LUTS focusing on what is evidence-based. EVIDENCE ACQUISITION: We searched the Medical Literature Analysis and Retrieval System Online (MEDLINE) database in February 2010 to retrieve English language studies (from 1997 to 2009) and the 2005, 2006 and 2007 abstract volumes of the European Association of Urology (EAU), American Urological Association (AUA) and International Continence Society (ICS). EVIDENCE SYNTHESIS: We present the findings according to the studied population in four groups: (a) children, (b) middle-aged women, (c) elderly and (d) neuropathic patients. Most published studies that correlated rectal and bladder dysfunction were carried out in children or in young women. On the other hand, there are few studies regarding the association between constipation and LUTS in the elderly and in neuropathic patients. CONCLUSIONS: Several studies in children documented that constipation is linked to urinary tract problems, including infections, enuresis, vesicoureteral reflux and upper renal tract dilatation. The underlying pathophysiology of these findings has not yet been clearly defined. Studies in middle-aged women also support a high prevalence of constipation among patients suffering from urinary tract dysfunction. Furthermore, an association between constipation and urinary incontinence, as well as between constipation and pelvic organ prolapse, has been suggested. The only prospective study in constipated elderly with concomitant LUTS demonstrates that the medical relief of constipation also significantly improves LUTS. Finally, the available data on neuropathic patients suggest that stool impaction in the rectum may mechanically impede bladder emptying. However, most of the studies only include a small number of patients, are not prospective and are uncontrolled. Therefore, there is a need for large-scale, controlled studies to further improve evidence and to provide a valid recommendation for all groups, especially for the elderly and neuropathic patients.

Com o objetivo de determinar as principais causas de morte em cães e gatos, foram analisadas informações correspondentes às fichas clínicas de cães e gatos provenientes de um hospital veterinário universitário entre julho de 2005 e julho de 2009. Durante o período estudado foram atendidos 2243 casos novos, sendo 2075 cães e 168 gatos. Em cães, o percentual de óbito foi de 10,6% (220/2075) e em gatos, 8,92% (15/168). A idade média quando do óbito em cães e gatos foi de 59,97 e 82,79 meses, respectivamente. Em cães, as principais causas de morte e razões para eutanásia foram distúrbios infecciosos ou parasitários, distúrbios causados por agentes físicos e neoplasias. Exceto pela idade, as demais características de resenha não influenciaram a expectativa de vida ou a causa de morte em cães. Em gatos, distúrbios provocados por agentes físicos e distúrbios urinários foram os principais motivos que resultaram na morte do animal. Os resultados observados identificam a necessidade de medidas profiláticas que possibilitarão maior expectativa de vida e, consequentemente, alteração na frequência das principais causas de morte e razões para eutanásia em cães e gatos.

Aims To report the conclusion of the Think Thank on Neurourology discussions during the first ICI-RS meeting in 2009. Methods During a 3-day meeting a group of specialists discussed evidence-based medicine in neurourology and made suggestions for future research. Results In the vast majority of patients with neurological disease bladder dysfunction occurs. The actual rules of diagnosis and treatment lack a study related evidence base. From a long list of possible research subjects, prevalence, detrusor pressure, imaging, catheterization and surgery have been first discussed. Conclusion In each of these subjects, research items are suggested which can help to improve the care in this patient group. Neurourol. Urodynam. 29:662–669, 2010. Copyright © 2010 Wiley-Liss, Inc.

Ninety-nine isotope, 4 CT and 10 MR examinations were carried out in 1990 to test urogenital disorders in infants and children. The procedures are described with sidelights on indication, difficulties of technical nature and comparison with internationally published reports. An examination strategy is devised, with estimation of its effectiveness in the follow-up and after-care.

Multivariate analysis (PC-CVA and GA-CVA) was carried out on time-of-flight secondary ion mass spectra (ToF-SIMS) derived from 16 bacterial isolates associated with urinary tract infections, with an objective of extracting the spectral information relevant to their species-level discrimination. The use of spectral pre-processing, such as removal of the dominant peaks prior to analysis and analysis of the dominant peaks alone, enabled the identification of 37 peaks contributing to the principal components-canonical variates analysis (PC-CVA) discrimination of the bacterial isolates in the mass range of m/z 1–1000. These included signals at m/z 70, 84, 120, 134, 140, 150, 175 and 200. A univariate statistical analysis (Kruskal–Wallis) of the signal intensities at the identified m/z enabled an understanding of the discriminatory basis, which can be used in the development of robust parsimonious models for predictive purposes. The utility of genetic algorithm (GA)-based feature selection in identifying the discriminatory variables is also demonstrated. A database search of the identified signals enabled the biochemical origins of some these signals to be postulated.

Background A 34-year-old, captive-born, vasectomized male chimpanzee (Pan troglodytes) presented with lethargy and scrotal swelling. Methods Urethral obstruction was diagnosed via urethroscopy. Results Removal of the grass stem foreign body resolved the obstruction. Scrotal and preputial ulceration developed from urine scald, which was managed with surgical debridement and antibiotics. Conclusions After 7 weeks, the animal was reintroduced to its troup and has been healthy for 11 months.

Background: Evidence indicates that maternal genitourinary infection during pregnancy is associated with increased risk of epilepsy in children and that children of women with epilepsy are substantially more likely to have epilepsy themselves. Research is lacking on whether maternal genitourinary infection has a different effect on children of women with epilepsy compared to children of women without epilepsy. Methods: We conducted a retrospective cohort study using Medicaid data for 127,540 pregnancies, from 1996 to 2002, and children’s data through 2008. Maternal epilepsy, genitourinary infections, and child epilepsy were identified. Epilepsy was diagnosed in 1.7% of the children in the cohort. Results: There was a statistically significant interaction between maternal genitourinary infection and maternal epilepsy. Maternal genitourinary infection was strongly associated with increased risk of epilepsy in children of women with epilepsy (hazard ratio = 3.74, 95% CI = 1.67–8.40). Infection was more weakly associated with increased risk of epilepsy in children of women without epilepsy (hazard ratio = 1.23, 95% CI = 1.12–1.34). Conclusions: There is a significant association between genitourinary infection and childhood epilepsy, and the impact appears to be greater in children of women with epilepsy. This finding has implications for prenatal care of women with epilepsy as well as for research on antenatal risk factors for child epilepsy.

The aim of this study was to evaluate the course of urethral obstruction in cats. Forty-five male cats with urethral obstruction or lower urinary tract signs referable to urethral obstruction were included in the study. Follow-up information was gained by telephone interview in most cases and was available in 39 cats. Of the 22 cats with idiopathic urethral obstruction, eight (36%) re-obstructed after 3–728 days (median 17 days). Of 10 cats with urolithiasis, three (30%) re-obstructed after 10, 13 and 472 days, respectively. Of the seven cats with urethral plugs, three (43%) re-obstructed after 4, 34 and 211 days, respectively. Recurrent signs of lower urinary tract disease including obstruction were common in cats with urethral obstruction (20/39; 51%) and occurred in the same frequency irrespective of the primary cause of the obstruction. Recurrent obstruction (14/39; 36%) was the most common reason for euthanasia and was performed in 8/39 (21%) cats.

Using transrectal palpation criteria, 111 cows were diagnosed to have cystic ovarian degeneration. Pretreatment milk samples were collected for progesterone analysis with a latex agglutination milk progesterone assay. The control group cows were treated with GnRH, regardless of their progesterone concentration (GNRH control). Treatment group cows were assigned to either luteotropic or luteolytic therapy based upon latex agglutination milk progesterone concentration (LA assigned). Gonadotropin releasing hormone or PGF2 alpha were administered to cows with low and high (>3.68 ng/ml) milk progesterone concentration, respectively. Prior work predicted that only 30% of the COD cow population would be classified as high progesterone concentration. To allow for an adequate sampling of PGF treated cows within the LA assigned group, only every third cow was randomly assigned to the GnRH control group. Comparable milk samples were collected from GnRH-treated cows on Day 10 and PGF-treated cows on Day 4 after treatment. Response to therapy was defined as a reversal in the pretreatment versus posttreatment milk progesterone concentration. Response to cystic ovarian degeneration therapy was 52.3% in the 44 GnRH control cows, versus 71.6% in the 67 LA assigned cows (P

The relationship between bladder cancer, occupation and exposure to a number of occupational agents was assessed in a case-control study conducted in the greater Milan area, Northern Italy. The case series consisted of 263 cases (219 males, 44 females) with histologically confirmed invasive bladder cancer, admitted to a network including major teaching and general hospitals in the area under surveillance. The controls were 287 patients (210 males, 77 females), admitted for acute, non-neoplastic or urinary tract diseases to the same network of hospitals. Cases more frequently reported occupation in dyestuff production (relative risk (RR) = 4.6), painting/spraying work (RR = 1.8), chemical industry (RR = 1.7), pharmaceuticals (RR = 1.7) and coal/gas production (RR = 3.1). Only for dyestuff production however, was the excess statistically significant. There was no association with agriculture or related activities, rubber manufacturing, printing, the petroleum industry, food processing and mechanics. In relation to exposure to occupational agents, significant positive trends in risk were observed for dyes/paints (RR = 4.8 for greater than ten years of exposure), herbicides (RR = 4.1), chemicals (RR = 2.4) and gases/fumes (RR = 4.8). No association was found with metals or metal dusts, plastic resins or glues, oil, wood dust, solvents or benzene, asbestos, electricity or radar and coal tar. Besides confirming the well known association between bladder cancer risk and dyestuff production and, to a lesser extent, a wide spectrum of chemical-related activities, this study provides statistically significant evidence of an independent role of herbicides on the risk of bladder cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

No Abstract.Kenya Veterinarian Vol. 14 1990: pp. 7-10

The design and development of a compact capacitive type uroflow transducer, based on the equation of continuity, is presented. The transducer was integrated with an expert system which diagnoses urinary tract diseases by using real-time urodynamic parameters obtained from the patient. The principle of operation of the proposed transducer is discussed. The system was developed around an IBM-compatible PC and can be used by a general practitioner. The system has been successfully evaluated. >

Durante um ano foi realizado um estudo epidemiológico em 10 sistemas de produção de suínos (produtores de leitões ou ciclo completo), com o objetivo de investigar os fatores de risco que melhor explicam as variações na produtividade da fêmea suína. Foi aplicado um questionário para obtenção de informações relacionadas a genética, sanidade, nutrição, instalações e manejo. As respostas envolveram 271 fêmeas. Elas foram submetidas a procedimentos estatísticos de análise descritiva, análise de correspondência múltipla e classificação hierárquica ascendente das fêmeas. Dessas, 236 (87,1%) pariram em média 11,4± 2,8 leitões, 31 (11,4%) apresentaram retorno ao estro, 3 (1,1%) abortaram e 1 (0,4%) apresentou falsa gestação. As variáveis explicativas que melhor discriminaram as fêmeas quanto ao número total de leitões nascidos (variável objetiva) foram: antecedentes reprodutivos, infecção urinária, temperatura retal no dia da cobrição e até quatro dias após, tempo de cobrição, método de cobrição e soroconversão para parvovírus. Os resultados sugerem que é possível melhorar o desempenho reprodutivo dos rebanhos suínos pela identificação e correção dos fatores de risco identificados neste estudo. An epidemiological study was performed with risk factors associated to the reproductive performance of the swine female. The objective was to identify risk factors with higher impact over the production. Ten piglet producers or complete rearing farms were surveyed for data collection on genetic, feeding, sanitary status, facilities and management practices of a total of 271 females. Descriptive analysis, multiple correspondence analysis and hierarchic ascending classification of the females were performed. The results showed that 236 (87.1%) sows had an average of 11.4± 2.8 piglets per pregnancy, while 31 (11.4%) returned to oestrus, 3 (1.1%) presented abortions and 1 (0.4%) showed false pregnancy. The variables presenting better ranking of the sows, according to the litter size, were previous reproductive history, presence of urinary infections, rectal temperature at the day of mating and at four subsequent days, length of mating, method of fertilization and seropositivity for porcine parvovirus. The results suggest that an improvement on reproductive performance is possible by identification followed by correction of the risk factors of higher impact.

Urinary microscopy is a diagnostic tool which is largely used by nephrologists. In the opinion of the authors the best results can be achieved when all the aspects concerning this test are properly taken into account. Thus, from the methodological point of view, proper patient guidance, proper urine collection and handling, adequate microscopic equipment, and knowledge of the factors which can influence the results are all necessary. All the elements of clinical importance have to be known, namely, erythrocytes (with their morphological subtypes), leukocytes, tubular cells, uroepithelial cells (both superficial and deep), lipids, casts, crystals, and microorganisms. Then, the urinary findings have to be interpreted and, whenever possible, also combined into urinary profiles (e.g., the nephritic sediment, the nephrotic sediment). This, combined with other laboratory tests, the pathologic findings, and the clinical data, allows for the definition and management of urinary tract diseases.

The annual congress of the European Association of Urology in Stockholm was packed with mixed poster/oral sessions wherein innovative clinical and preclinical research aimed at improving the care of patients with urinary tract diseases was reported and open for discussion. Not everything that was reported during the meeting can be captured in a single report, but the following text will guide readers through the most significant new findings directly related with pharmacotherapy for overactive bladder, urinary tract cancer and other common medical conditions that endanger the quality of life and life expectancy of many patients worldwide.

As Doencas do Trato Urinario Inferior Felino (DTUIF) sao frequentes na rotina clinica desta especie, e decorrente de diversos processos morbidos caracterizados por hematuria, disuria, polaciuria, estranguria, periuria e obstrucao uretral, que afetam principalmente felinos sedentarios, de vivencia intradomiciliar e com baixa ingestao de agua. Com o objetivo de verificar as principais alteracoes clinicas, laboratoriais e ultrassonograficas nos casos de DTUIF, foram examinados 26 felinos no Hospital Veterinario da UFMT, sendo, 16 com DTUIF e dez higidos, notando-se que todos os animais doentes apresentaram azotemia, valor medio da concentracao serica de calcio total diminuido e elevacao na concentracao serica de fosforo. Crescimento bacteriano foi observado em um terco dos casos, sendo tres possivelmente decorrentes de cateterizacao vesical, ja que eram casos recidivantes. Os achados ultrassonograficos foram compativeis com quadros de obstrucao, tais como: distensao acentuada da vesicula urinaria e debris em suspensao, dilatacao de ureteres e uretra.

Hematuria is a significant manifestation, which can reflect both renal disorders and other urinary tract diseases and also be a symptom of systemic illnesses. High prevalence, diversity of etiological and trigger factors, latent course of hematuria and phenotypic resemblance of a number of underlying nephropathies symptoms cause increased interest and urgency of further investigations of such diseases features. The examination of 56 children showed that the most common cause of glomerular hematuria was hereditary kidney diseases, associated with collagen IV type mutations — 64% (Alport syndrome — 56%, thin basement membrane disease — 44%) and IgA-nephropathy — 36%. Comparative analysis of these conditions is presented in this study.

As Beijing was selected as the site for this year's International Continence Society (ICS) meeting, crowds of locals navigating through the subway train lines and tourists lining up for access to the Forbidden City and other landmarks were joined by a less numerous but a still significant number of researchers, scientists and practitioners working on urinary tract diseases and disorders going to the China National Convention Center to attend the podium and poster sessions. Located next to the Bird's Nest Olympic stadium and offering grand views over the Olympic park from the upper floor where non-discussion posters were displayed, the modern facilities allowed for a smooth, seamless meeting during which a number of highly relevant new findings were discussed. The following report summarizes selected presentations on pharmacotherapy and drug candidates for overactive bladder and other common diseases of the urinary tract.

Urolithiasis is a common problem in both ruminants and non-ruminants and nutrition plays a significant role in predisposing urolithiasis. The nutritional factors mainly influence urinary constituents and pH, which affect stone nucleation and growth. While surgery can render a patient stone-free, non-operative treatment modalities are required to prevent and reduce the risk of recurrent urolithiasis. Moreover, long-term pharmacological therapy and its potential side effects often lead to subsequent failure. In this regard, nutritional management is the best preventive strategy against urolithiasis.

This study included 328 cases (106 with bladder cancer, 152 with non-malignant urinary tract diseases and 70 healthy controls). Serum TPA was determined using the Prolifigen TPA IRMA kit supplied by AB Sangtec Medical, Bromma, Sweden and serum TPS was determined using the TPS IRMA kit supplied by Beki Diagnostics AB, Bromma, Sweden. The results of this study revealed that serum TPA had better sensitivity than serum TPS while no marked difference was found in the false-positivity rates in the non-malignant urinary tract diseases, A correlation coefficient of 0.83 was found between serum TPA and TPS. No relation was found between either TPA or TPS and histopathological stage, grade or association of the tumor with bilharziasis. As regards the histopathological type of the tumor, serum TPS was slightly higher in squamous cell than transitional cell carcinoma but TPA showed no difference. In the follow-up of bladder cancer patients after surgery both TPA and TPS showed an excellent concordance with the clinial state of the patients. In conclusion, TPS does not seem to be an optimal test in Egyptian patients with bladder cancer but serial determinations of one of the two markers can be used in the follow-up of these patients after surgery.

Microbubbles produced by cavitation in vivo could be used as ultrasound contrast agents without the need for injection. If produced in the bladder, microbubbles could be used to diagnose urinary tract diseases such as urinary reflux. In this study, the production of these bubbles was investigated. Urinary bladders were removed from dogs immediately after sacrifice with care taken to prevent the urine from draining or becoming contaminated. These bladders were exposed to a series of high-amplitude pulses from a Dornier HM-3 lithotripter. Small scatterers were produced by these fields which rapidly dissolved into the fluid when no other action was taken. These scatterers were identified as cavitation bubbles produced by the high-amplitude field. A continuous, standing field was used to try to prevent the dissolution of the bubbles through rectified diffusion

Urinary tract infection (UTI) is one of the most frequently encountered problems in ambulatory medicine. The present study was designed to determine siderophore production as the urovirulence factor of Escherichia coli isolated from the patients of UTI. A total of 160 strains of E. coli isolated from urine of patients with clinically diagnosed UTI were included in the study and 50 fecal isolates of E. coli, siderophore production was seen in 156 (97.5%). In 50 fecal isolates, siderophore production was seen in 2 (4%). Siderophore production has been shown to be more frequent in E. coli from patients with UTI, than in fecal isolates. The results suggest that siderophore production positive strains can be considered as UPEC. Thus, although a great deal has been learned regarding E. coli virulence mechanisms in UTI, much remains to be learned and the practical application of our growing understanding of E. coli virulence factors to the prevention and treatment of UTI has to be continued.

Symptoms, signs, and laboratory findings that indicated excretory urography in 1,622 patients, were compared with the radiographs. The chance that an indication would be associated with demonstrable disease was calculated. No "low-likelihood" indications could be identified. Elimination of the urograms obtained for any of the indications would not have been possible without simultaneously precluding detection of many diseased patients. The monetary cost of case-finding was low, and the efficacy of patient referral high.