Urine profiles and kidney histology after ionic and nonionic radiologic and magnetic resonance contrast media in rats with cisplatin nephropathy

RATIONALE AND OBJECTIVES: The nephrotoxic drug cisplatin has been used successfully in treating some cancers. Patients with suspected carcinoma frequently undergo examinations with contrast media. We examined whether ionic and nonionic radiologic and magnetic resonance contrast media would have any effect on cisplatin nephropathy in rats. METHODS: Urine and serum profiles were monitored for 24 days after intravenous (i.v.) injections of saline, diatrizoate, iohexol, gadopentetate dimeglumine, and gadodiamide in high doses (4.59 mmol/kg body weight) in rats that received a weekly intraperitoneal (i.p.) injection of cisplatin (1 mg/kg) for 10 weeks. There were 10 rats in each group. Another 10 rats injected with both i.p. and i.v. saline served as control subjects. After euthanization, rats' kidneys were removed for examination by light microscopy and electron microscopy. RESULTS: Light and electron microscopy showed severe morphologic changes, including tubular dilatation, atrophy, and necrosis induced by cisplatin; however, the contrast media did not induce any additional morphologic changes. Gadopentetate dimeglumine, diatrizoate, and iohexol significantly increased (3-20 times) albuminuria compared with i.v. saline in cisplatin nephropathy, whereas gadodiamide did not. Albuminuria was highest after diatrizoate injection. All four contrast media caused an immediate and transient significant increase in the excretion of the brush border enzymes alkaline phosphatase and gamma-glutamyltransferase (125-500 times) and the cytoplasmatic enzymes alanine aminopeptidase and lactate dehydrogenase (16-100 times). Compared with saline, the ionic agents significantly increased the excretion of both glucose (two times) and sodium (three to five times), whereas the nonionic agents did not. CONCLUSION: High doses of radiologic and magnetic resonance contrast agents cause temporary dysfunction in rats with cisplatin nephropathy. Gadodiamide caused the least dysfunction and diatrizoate the most.     

Aspirin and fraxiparine in the prevention of laser induced thrombosis in the presence of iodinated contrast media

The purpose of this study was to investigate the thromboembolic properties of ionic and nonionic contrast media in rats pretreated with aspirin and/or fraxiparine using an experimental model of laser induced thrombosis in the mesenteric microvessels of 17 groups of five male Wistar rats each. Two ionic (ioxaglate and diatrizoate) and two nonionic contrast media (iopamidol and iohexol), alone or associated with antithrombotic drugs (aspirin and/or fraxiparine) were studied. To evaluate the effects of these substances in this model, the number of laser beams needed to induce platelet thrombus formation, the number of emboli detached from the thrombus and the duration of embolization were quantified. Platelet aggregation induced by ADP, induced hemorrhagic time (IHT) and haemoglobin loss level were also determined. Both contrast media injected at 3 ml/kg caused a significant increase in the number of emboli and the duration of embolization (p<0.05). Pretreatment with aspirin and/or fraxiparine in the presence of ionic contrast media showed antithrombotic activities equal to those obtained when they were tested alone (p<0.05), while in the presence of nonionic contrast media, these drugs only neutralised the prothrombotic effects. There were no differences with the NaCl treated group (p>0.05). The ionic contrast media, and to a lesser extent the nonionic contrast medium: iohexol, inhibited platelet aggregation, while iopamidol behaved as an activator. The antithrombotic drugs tested in this study prevent the prothrombotic activities of contrast media therefore suggesting their use before radiographic procedures.     

Molecular cloning and functional expression of a recombinant 72.5 kDa fragment of the 110 kDa regulatory subunit of smooth muscle protein phosphatase 1M

RATIONALE AND OBJECTIVES: We compared adverse reactions and image quality for hysterosalpingography (HSG) performed with ionic (diatrizoate meglumine combined with iodipamide meglumine [DM + IM]) and nonionic (iohexol) contrast media. METHODS: We performed a study of 95 patients who had HSG and were randomly selected to receive DM + IM or iohexol. Patients reported episodes of abdominal pain and other adverse reactions immediately and 24 hr after the procedure and categorized severity of symptoms on a subjective scale. Two radiologists evaluated image quality for diagnosis. RESULTS: Prevalence of abdominal pain and other reactions both immediately and 24 hr after HSG was lower in patients who received iohexol than in patients who received DM + IM. Moderate or severe abdominal pain was significantly lower in the iohexol group than in the DM + IM group (p < .05). Visualization of the uterine cavity and ampullary rugae was judged excellent with both contrast media (87% with iohexol and 92% with DM + IM). CONCLUSION: Iohexol and DM + IM are excellent contrast media for use during HSG; iohexol 300 may cause fewer episodes of more severe and prolonged abdominal pain.     

Quantitative assessment of platelet function and clot structure in patients with severe coronary artery disease

RATIONALE AND OBJECTIVES: Although systemic absorption of enterically administered iohexol and its excretion in urine has been previously documented in rats with ischemic bowel, a practical and sensitive method of detecting urinary iohexol has not been available. We proposed to detect the presence of iohexol in the urine of rats with normal and ischemic bowel by use of a computed tomography (CT) number increase in the bladder with the use of CT. METHODS: Anesthetized rats (250 g) underwent either sham laparotomy (n = 6), ligation of two vascular arcades to the proximal jejunum (n = 5), ligation of six vascular arcades to the proximal jejunum (n = 6), or ligation of the superior mesenteric artery (n = 6). Rats were hydrated with saline (3.2 ml/hr intravenously). Each received a 3-ml enteric bolus of isotonic iohexol. Serial CT scans and plain film radiographs of the bladder were performed at 2, 4, and 6 hr to detect systemic absorption of contrast from the gut. Urine iohexol concentrations were measured by capillary electrophoresis. CT number and iohexol concentration were compared with evidence from plain film radiographs of bladder opacification. Intestinal ischemia was graded histologically. RESULTS: Histologic evidence of ischemia was present in all six-arcade and five of six superior mesenteric artery (SMA)-ligated animals. No animals in the control or two-arcade group showed evidence of bowel ischemia. Statistically significant increases (P < 0.05) in bladder density were demonstrated in the six-arcade and SMA-ligated groups. No statistical difference was noted between the two-arcade ligation and control groups. CONCLUSIONS: Experimental intestinal ischemia was reliably detected by bladder opacification after administration of enteric contrast. CT detection of systemic absorption of enteric iohexol was more sensitive than plain film radiographs and may be useful in the diagnosis of intestinal ischemia, although it may not be specific for ischemia.     

Description of costs and effectiveness of a hypertension control program in primary care]

Our purposes were to determine whether sonography can distinguish between obstructed and nonobstructed rats and to compare the diagnostic accuracy of sonography and radiography in the diagnosis of small bowel obstruction. Nonstrangulating small bowel obstruction was created in 19 rats; sham laparotomies were performed in 18 controls. Serial radiographs and sonograms, including duplex Doppler sonography, were obtained. Bowel diameter and bowel wall thickness were evaluated retrospectively. Bowel diameter, bowel wall thickness, and resistive indices increased in the animals with obstruction; controls remained unchanged (P = 0.002). Sonography demonstrated a significantly higher diagnostic accuracy than radiography at 24 hours and beyond (P = 0.023). Ultrasonography is sensitive and more accurate than radiography in diagnosing small bowel obstruction using objective criteria in the animal model.     

Contrast media-induced renal morphologic lesions in diabetic rats

Diabetes mellitus was induced in rats with streptozotocin and after 3 months the animals (n = 48) received an i.v. injection of 1 or 3 g I/kg in the form of high-osmolar diatrizoate, low-osmolar iopromide or iohexol, or of 0.6 g I/kg of high-osmolar Gd-DTPA. The controls were given an i.v. injection of physiologic saline. After 2 hours the kidneys were fixed by perfusion and the renal morphologic changes were semiquantitatively analyzed by two independent observers unaware of the agent administered. The contrast media (CM) induced pronounced cytoplasmic vacuolization in the proximal convoluted tubular cells. Such a lysosomal alteration may indicate CM uptake into the cell, and the ultrastructural evaluation revealed intracellular injuries related to the process. The alterations were most marked following administration of iohexol, but diatrizoate also induced a statistically highly significant vacuolization (p < 0.001). The lysosomal alterations following iopromide administration were not as striking, and Gd-DTPA induced only minor changes.     

Use of tissue culture to examine neurotoxicity of contrast media

The effect of small concentrations of diatrizoate, ioglycamate, and iopanoate salts on cultured sympathetic ganglia was studied. Biliary contrast media in clinical blood concentrations caused severe degeneration of cultured neurons, but similar concentrations of diatrizoate caused no effect. This technique may be used to measure the direct neurotoxicity or general cytotoxicity of contrast media.     

Evaluation of contrast media for bronchography

BACKGROUND: Bronchography is occasionally needed for the evaluation and management of some congenital pulmonary anomalies as well as some acquired diseases, usually of the tracheo- bronchial tree. There is currently no effective, approved contrast agent for this imaging techniq ue. OBJECTIVE: We evaluated five agents (barium sulfate, iohexol, propyliodone oily, propyliodone aqueous, and perflubron) in terms of image quality, histologic changes, and effects on hemodynamics, blood gases, and standard laboratory tests in New Zealand White rabbits. MATERIALS AND METHODS: Animals were anesthetized and intubated. Each contrast agent (0.25 ml/kg) was administered intratracheally. Three animals in each group had intravenous lines placed for blood sampling and blood pressure monitoring and were sacrificed at 1 h. An additional three animals for each agent were sacrificed at 24 h and 1 week after imaging. Blood samples were taken immediately before contrast instillation and at 1 h postbronchography. Fluoroscopic images were recorded on standard VHS video tape and evaluated in blind fashion. Segments of lung tissue and bronchi were obtained for histologic examination. RESULTS: Necrosis and/or inflammatory infiltrates were noted in 78 % of the bronchograms performed with propyliodone aqueous, 67 % with propyliodone oily, 55 % with perflubron, and 33 % with iohexol 120, 240 and 350. No histologic damage was observed with barium. The propyliodones gave the best-quality imaging results and the most histologic changes. Iohexol, in any concentration, gave the least acceptable images and a moderate number of histologic changes. Barium sulfate demonstrated acceptable images with virtually no histologic changes. CONCLUSION: From the histologic and imaging results, barium is the best available contrast material for bronchography.     

Gas chromatography determination of polychlorinated biphenyls in powdered and liquid soybean milks

OBJECTIVE: To compare the inhibitory effects of propiverine HCl(BUP-4) with those of atropine and oxybutynin on the detrusor instability induced by partial obstruction of the bladder neck of female rats. MATERIALS AND METHODS: Partial obstruction was created using partial ligation of the proximal urethra in 20 female Sprague-Dawley rats. Both the obstructed rats and a control group of 15 rats were evaluated cystometrically about 6 weeks later and the values compared both baseline and after injection with BUP-4, atropine or oxybutynin. During cystometry, the bladder capacity (BC), residual volume (RV), compliance and frequency of spontaneous activity (SA) were determined. RESULTS: The BC, RV and frequency of SA were significantly increased, and compliance markedly decreased, in obstructed compared with normal rats. The micturition pressure was significantly decreased only after injection with BUP-4 in both normal and obstructed rats. For both, the BC was increased significantly after injection with atropine or BUP-4 (P < 0.05), with the increase greater after BUP-4 than after atropine in both groups (P < 0.01). After injecting BUP-4, the RV was significantly increased in both groups (P < 0.05); atropine increased the RV only in normal rats (P < 0.01) and oxybutynin had no significant effect on RV. Increases in compliance after the administration of each drug were significant only in obstructed rats (P < 0.01) and were markedly higher after oxybutynin (780%) than after the other drugs (180-250%). The frequencies and amplitude of SA after injection with each drug were significantly lower only in obstructed rats, but in these rats, there were no significant differences in this reduction after injecting oxybutynin or BUP-4, whereas they were significantly greater after injecting oxybutynin than after atropine. CONCLUSION: Partial bladder outlet obstruction successfully created a hyperactive (unstable) bladder, typified by increased BC, RV, frequency of SA and a marked decrease in compliance. The greater BC, lower MP and frequency and amplitude of SA were prominent after the administration of BUP-4. Thus it is suggested that BUP-4 effectively inhibited bladder instability in rats induced by infravesical outlet obstruction and was more effective than oxybutynin in increasing BC.     

The ''penumbra sign'' on T1-weighted MR imaging in subacute osteomyelitis: frequency, cause and significance

OBJECTIVE: To find out the incidence, aetiology, and outcome of patients operated on for small bowel obstruction after previous operation for colorectal cancer. DESIGN: Retrospective cohort study. SETTING: District hospital serving a defined population, Norway. SUBJECTS: 472 consecutive patients operated on for colorectal cancer, followed up for a median of 5.5 years (range 2.0-16.8) or until death; 351 had had a resection with curative intent, and 121 a palliative operation. MAIN OUTCOME MEASURES: Incidence and aetiology of small bowel obstruction, postoperative mortality, and long term survival. RESULTS: Small bowel obstruction necessitated operation in 36/351 (10%) after resection with curative intent, and in 5/121 (4%) after a palliative operation. The causes of obstruction were benign adhesions (n=21), local recurrence (n=17) and peritoneal carcinomatosis (n=3). One patient died of a myocardial infarction and six of cancer within 30 days of the operation for small bowel obstruction. The estimated median survival after the operation for small bowel benign obstruction was 1.9 years (SE=0.6) compared with 0.36 years (SE=0.04) for malignant obstruction (p=0.0007, logrank test). Late small bowel obstruction by adhesions was associated with higher blood loss during the primary operation (p=0.02). None of the 62 patients who took thiazide diuretics at the time of the primary operation later developed obstructive adhesions. CONCLUSION: 41/472 patients (9%) developed small bowel obstruction after the primary operation for colorectal cancer. The aetiology was benign in 21 and malignant in 20 patients. Survival after operation for the obstruction was far better with benign than with malignant obstruction.     

Effects of iodinated contrast media on pulmonary airway resistance in anesthetized guinea pigs

RATIONALE AND OBJECTIVES: Bronchospasm is occasionally observed following iodinated X-ray contrast medium administration. We performed an in vivo study in guinea pigs to investigate the effects of a number of iodinated contrast media on pulmonary airway resistance and the mechanisms underlying the potential bronchoconstrictor effect. METHODS: The contrast media studied were the pharmaceutical formulations of iomeprol (400 mg I/ml), iopamidol (370 mg I/ml), and iohexol (350 mg I/ml), which are nonionic, triiodinated contrast media; diatrizoate (370 mg I/ml), an ionic, triiodinated contrast medium; iotrolan (300 mg I/ml), a nonionic, hexaiodinated contrast medium; and iocarmate (280 mg I/ml) and ioxaglate (320 mg I/ml), which are both hexaiodinated and ionic contrast media. Each contrast medium was administered intravenously at 2 g I/kg. Changes in pulmonary airway resistance were evaluated by measuring intratracheal pressure at the moment of maximum insufflation, or maximal insufflation pressure (MIP), in anesthetized guinea pigs submitted to forced ventilation. RESULTS: All contrast media except ioxaglate caused mean increases of MIP of no more than 20%. By contrast, ioxaglate caused a marked bronchoconstrictor effect, increasing MIP by 242% +/- 46%. Of the drugs tested for antagonistic action on this increase in MIP, salbutamol inhibited almost completely the increase in MIP for the first 40 min posttreatment. Similarly, lysine acetylsalicylate and indomethacin consistently reduced MIP after contrast media administration to levels only 30% and 14% above those of baseline precontrast media, respectively. Promethazine had only a minor inhibitory effect, and the response to prednisolone varied. CONCLUSION: There was no apparent relationship between the size of the increase in airway resistance and the charge or molecular weight of the contrast agent molecule or the pharmaceutical formulation. The increase induced by ioxaglate must be attributed to inherent molecular toxicity mediated through a direct action on the production of bradykinin and/or the prostanoid products of the cyclooxygenase pathway, rather than through a direct action on the release of histamine.     

Medical malpractice involving radiologic colon examinations: a review of 38 recent cases

OBJECTIVE: Our purposes were to determine the causes of malpractice claims against radiologists performing contrast examinations of the colon and to design strategies to reduce litigation and diminish patient morbidity. MATERIALS AND METHODS: Reports of malpractice claims were collected from legal journals and databases between 1985 and 1994. For this period, 38 plaintiffs raised 52 allegations of malpractice that involved radiologists performing barium or Hypaque (meglumine diatrizoate; Winthrop Pharmaceuticals, New York, NY) colon examinations. For the 38 cases, 18 plaintiffs for decedents alleged that failure to diagnose colorectal cancer by barium enema examination caused delay in treatment and the patient's death. Eighteen plaintiffs alleged that improper performance of barium (17 cases) or meglumine diatrizoate (one case) colon examinations caused perforation of the colon, resulting in significant morbidity (15 cases) or death (three cases). Miscellaneous causes for malpractice claims were recorded in two cases. RESULTS: In 18 cases of failure to diagnose colorectal cancer, the initial radiographs were interpreted as follows: normal findings in 14 cases, diverticulosis in one case, and spastic bowel in two cases; in the remaining case, colon cancer was missed because of nonopacification of the cecum. In retrospect, 17 of 18 colorectal cancers were visualized. The delay in the diagnosis of colorectal cancer ranged from 5 to 72 months. Missed colorectal cancers occurred in the cecum (two cases), transverse colon (two cases), rectosigmoid area (nine cases), or unspecified area (five cases). In 18 cases of colon perforation, the site was the cecum (one case), transverse colon (one case), extraperitoneal rectum (seven cases), rectosigmoid area (one case), colostomy stoma (two cases), or unspecified area (six cases). One patient experienced anaphylactic shock that required hospitalization. One underwent unnecessary surgery because barium enema films showing colon cancer were mislabeled with her name. CONCLUSION: On the basis of our analyses of malpractice claims, we suggest strategies to prevent medicolegal litigation. Strategies include communicating with the patient about the type and indications of the barium enema examination, performing digital rectal examinations on all patients to detect distal rectal lesions or strictures, recognizing colon perforation, and obtaining immediate surgical consultation if colon perforation occurs. The number of missed colon cancers may be reduced by reading twice or reviewing at a later time all barium enema examinations.     

Comparative study between corpus cavernosum-electromyography findings and electron microscopy of cavernosal muscle biopsies in erectile dysfunction patients

BACKGROUND/AIMS: The colonic response to obstruction is poorly understood. Thickening of the proximal bowel following colonic stricture may be due to increased protein synthesis. We have investigated the colonic morphology and collagen concentration during the development of left-sided colonic obstruction in an animal model. METHODS: Twelve male Wistar rats received either a silk ligature obstruction of the colon 2.5 cm above the peritoneal reflection (n = 6) or manipulation of the left colon (controls, n = 6). Twenty-four hours later, three colonic specimens from the ligature zone and from 1 cm proximal and distal to this site, or from equivalent regions in controls, were assayed for hydroxyproline concentration. RESULTS: In controls there was no difference in hydroxyproline concentration between colonic sites. In obstructed rats, the hydroxyproline concentration was greater both at the ligature and distally, when compared with the proximal region. The hydroxyproline concentration was higher (p < 0.05) than corresponding control values at the ligature site (14.95 +/- 2.76 vs. 10.97 +/- 1.95 microgram/mg of dry tissue mean +/- s.d.) but not on either side. CONCLUSION: The colonic collagen concentration is equivalent or raised near an obstruction, demonstrating that obstructed colon may possess an enhanced capacity to hold sutures.     

Histamine release and contrast media-induced renal vasoconstriction

RATIONALE AND OBJECTIVES: The authors' purpose was to investigate the role of histamine release causing renal vasoconstriction induced by application of contrast media, an important element in contrast medium-induced nephrotoxicity. MATERIALS AND METHODS: Isometric contractions in rabbit segmental renal arteries stimulated with KCl and increasing concentrations of the ionic contrast medium diatrizoate and the nonionic agents iomeprol and iodixanol were studied both with and without increasing concentrations of the histamine H1 and H2 blockers diphenhydramine and cimetidine. Histamine concentrations after contrast medium application were determined. RESULTS: Contrast-induced, dose-dependent, reversible renal artery contractions of 27%, 4.5%, and 5% of the control KCl contraction were found for diatrizoate, iodixanol, and iomeprol respectively. Those induced by the ionic contrast medium were statistically significantly higher (P < .01). Contractions were partially inhibited by diphenhydramine (49%) but not by cimetidine. Significant elevation of histamine concentrations (P < .05) was detected only after stimulation with diatrizoate but not with nonionic agents. CONCLUSION: Ionic contrast medium induces histamine release leading to renal vasoconstriction, which can be partly blocked by H1 blockers. Histamine has no effect on renal vasospasm induced by nonionic contrast media.     

Short tube decompressive jejunostomy

Experience with short tube decompressive jejunostomy in twenty-nine patients with small bowel obstruction is presented. Many advantages are gained by operative decompression of obstructed, dilated small bowel. The favorable results with its use make short tube decompressive jejunostomy a safe, acceptable method of decompressing dilated small bowel.     

Water-soluble contrast study predicts the need for early surgery in adhesive small bowel obstruction

BACKGROUND: The optimal period of conservative treatment for adhesive small bowel obstruction remains controversial. This study sought to determine whether a 24-h abdominal radiograph after oral Urografin is a reliable indicator for operation in patients with adhesive small bowel obstruction. METHODS: One hundred and sixty-one patients who suffered from adhesive intestinal obstruction without clinical evidence of strangulation or gangrene underwent a Urografin study. Some 40 ml Urografin mixed with 40 ml distilled water was administered either orally or via a nasogastric tube to each patient. Serial plain abdominal radiographs were taken 4, 8, 16 and 24 h later. If an earlier plain radiograph showed that contrast medium had reached the ascending colon, subsequent radiographs were not taken. RESULTS: Contrast medium reached the colon within 24 h in 112 patients (70 per cent). These patients were all treated successfully with non-operative methods. Contrast medium was not observed in the colon within the first 24 h in 49 patients (30 per cent). Operation was performed in 47 of these patients and non-operative treatment was given in two. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of Urografin reaching the colon within 24 h as an indicator for non-operative treatment were 98, 100, 99, 100 and 96 per cent respectively. CONCLUSION: All patients with evidence of Urografin reaching the colon within 24 h were treated successfully with non-operative methods. The results of this prospective study suggest that patients with adhesive intestinal obstruction in whom contrast medium fails to reach the colon within 24 h should receive prompt surgical intervention.     

Giant jejunoileal duplication: prenatal diagnosis and complete excision without intestinal resection

A 7-week-old child presented to the pediatrician after persistent vomiting and abdominal distension developed. Intestinal dilatation had been detected in utero. Emergency ultrasonography showed only small bowel dilatation. There were no signs of intestinal obstruction; however, complete intestinal malrotation was demonstrated by an upper gastrointestinal series and barium enema. Intestinal duplication was also suspected, and emergency laparotomy was performed. A 70-cm-long jejunoileal duplication was found and successfully dissected free from the normal small bowel and excised without intestinal resection-anastomosis. The authors describe this unique case and the surgical technique for the treatment of small bowel duplications.     

Resolution of late potentials with improvement in left ventricular systolic function in patients with first acute myocardial infarction

BACKGROUND: Little has been written about the use of computed tomography (CT) in the evaluation of small bowel obstruction (SBO) in children. The purpose of this study is to review the CT findings of SBO in a pediatric series and to increase awareness of CT as potential problem-solving tool for SBO in children. METHODS: The medical, surgical, radiographic, and CT scan records of 20 consecutive children with surgically proven SBO were retrospectively reviewed. Duodenal and neonatal obstruction was excluded. CT scans were evaluated for small and large bowel caliber, bowel wall thickening, the appearance of the mesentery, extraluminal abnormalities, and the ability to detect the cause of obstruction. RESULTS: Causes of obstruction included adhesions (nine), small bowel intussusception (four), abscess (two), segmental volvulus (two), Crohn disease (one), focal stricture (one), and internal hernia (one). Small bowel dilatation was present in 19/20 children. Small bowel caliber transition was noted in 17/19 children. Two children with no small bowel caliber transition had a collapsed colon. The colon appeared normal in caliber in nine children, collapsed in nine, and filled with stool proximally and collapsed distally in two. Small bowel thickening was present in six children and mesenteric venous engorgement in three. Specific causes of obstruction were identified on CT in nine children (45%) and could be correctly predicted in seven of nine children with adhesions. In four children, the causes were either not evident or alternate diagnoses could be made. CONCLUSION: CT can be a useful adjunct in evaluating the presence or causes of SBO in children.     

Beneficial effects of Tadenan therapy after two weeks of partial obstruction in the rabbit

Tadenan (Debat Laboratories, France) is a plant extract used in Europe for the treatment of micturition disorders associated with benign prostatic hypertrophy (BPH). Prior studies demonstrated that pretreatment of rabbits with Tadenan significantly reduced the contractile dysfunction observed after 2 weeks of partial outlet obstruction. The specific aim of the present study was to determine the effect of Tadenan therapy following the creation of partial outlet obstruction. Two sets of experiments were performed: one with mild and the other with severe outlet obstruction. For both sets of experiments, male New Zealand rabbits (3-5 kg) were separated into 3 groups of 5 rabbits each. Each rabbit in groups 1 and 2 was obstructed using standard methodology. Rabbits in group 3 served as controls and did not receive any surgery. After 2 weeks, each rabbit in group 1 received Tadenan orally at 100 mg/kg/day for 3 weeks; each rabbit in group 2 received vehicle (peanut oil). After 3 weeks of treatment (5 weeks after partial outlet obstruction), rabbits were anesthetized and cystometries were performed. Immediately after cystometry, the rabbits were euthanized, the bladder rapidly removed, and 4 longitudinal strips prepared and mounted in individual baths for contractile studies. The contractile responses to field stimulation, carbachol, adenosine-5'-triphosphate (ATP), and potassium chloride (KCl) were determined, as follows: (1) Bladder mass approximately doubled in the mildly obstructed groups. Bladder mass increased significantly (3-5-fold) in the severely obstructed groups. (2) Cystometrograms from the mildly obstructed rabbits treated with peanut oil showed low compliance, whereas those of the mildly obstructed rabbits treated with Tadenan showed normal compliance. The cystometrograms of all severely obstructed rabbits showed low compliance. (3) Mild obstruction caused small but significant decreases in the contractile response to field stimulation that were reversed by Tadenan treatment. No changes were noted in response to bethanechol, ATP, and KCl stimulation. (4) Severe obstruction caused significant decreases in the response of bladder strips to field stimulation and bethanechol. Following Tadenan therapy, there was a significant improvement in the response to high-frequency field stimulation and a substantial improvement in the response to bethanechol (response equal to control). No changes were noted in response to ATP and KCl stimulation. In conclusion, Tadenan treatment reversed the bladder dysfunctions induced by mild partial outlet obstruction, and resulted in improved bladder function in the severe model of outlet obstruction. These studies are consistent with previous studies showing that Tadenan pretreatment protects the bladder against the development of contractile dysfunctions.     

Small bowel stenosis from blunt abdominal trauma

A patient with a segmental stricture of the small bowel resulting from blunt abdominal trauma is reported. Symptoms and signs developed as vague abdominal distension with chronic, incomplete small bowel obstruction four weeks after the accident. A small bowel barium examination provided the important images for preoperative evaluation.