L'échocardiographie sur le foetus a risque: expérience de 3 ans d'une consultation specialisée

L'échocardiographie foetale (bidimensionnelle en temps réel et en M-mode) se pratique chez nous depuis 3 ans dans le cadre d'une consultation spécialisée. L'indication pour une évaluation cardiaque a été posée à cause d'un facteur de risque familial chez 78 cas, pour des raisons foetales chez 78 grossesses, pour un problème maternel 9 fois. Dans 25 cas, aucune indication spécifique n'a existé. L'examen échocardiographique a été pratiqué entre la 18ème et la 39ème semaine de la grossesse (moyenne: 28ème semaine). Parmi 190 grossesses, dont 169 à haut risque, nous avons mis en évidence 33 cas de malformation cardiaque (17,4%) dont 14 cardiopathies complexes graves et 3 arythmies isolées (1,6%) mais nécessitant un traitement pendant la grossesse. Les porteurs de telles malformations ont bénéficié d'une surveillance appropriée et de soins immédiats lors de leur naissance. Dans 154 grossesses, les futurs parents ont pu être rassurés.Les malformations cardiaques congénitales sont les anomalies congénitales les plus fréquentes; elles peuvent être dépistées par un examen ultrasonore approfondi. Il devient donc impératif qu'un dépistage échocardiographique soit réalisé de manière systématique par des obstétriciens dans la 18ème semaine de gestation. Les foetus à risque bénéficieront ensuite d'une surveillance appropriée dans un centre spécialisé grâce à la collaboration étroite entre obstétriciens, néonatologues, cardiologues-pédiatres anesthésistes et chirurgiens cardio-vasculaires.     

The effect of metformin treatment on ovarian stromal blood flow in women with polycystic ovary syndrome

Objective  To evaluate the effects of metformin on the ovarian stromal blood perfusion in the patients with polycystic ovary syndrome (PCOS). Methods  Twenty-five women with PCOS who underwent a Doppler examination of the ovarian stroma was evaluated; hormonal, anthropometric, and biochemical parameters of patients were determined. After the patients were treated with 850 mg metformin twice a day for 6 months, the same parameters were evaluated in the same patients. Results  After metformin treatment, although pulsatility index (PI) was increased from 1.80 ± 1.23, 1.84 ± 1.28 to 2.20 ± 1.10, 2.19 ± 0.83 in the right and left ovary, respectively, and resistance index was increased from 0.84 ± 0.25, 0.83 ± 0.23 to 1.16 ± 0.37, 1.10 ± 0.26 in the right and left ovary respectively (P < 0.05), peak systolic velocity (PSV) was decreased from 12.30 ± 1.72, 12.34 ± 1.55 to 10.25 ± 0.97, 10.53 ± 1.33 in the right and left ovary respectively (P < 0.05). PI and RI did not show any difference between the homeostatic model assessment insulin resistance index (HOMA-IR) ≥ 2.38 and HOMA-IR < 2.38 groups before and after metformin treatment (P > 0.05). However, PSV was decreased significantly from 13.05 ± 1.35, 12.82 ± 2.02 to 11.03 ± 0.71, 10.25 ± 0.42 in HOMA-IR ≥ 2.38 group in the right and left ovary, respectively, and PSV was decreased from 11.50 ± 2.67, 11.28 ± 0.26 to 9.10 ± 0.58, 9.28 ± 0.25 in HOMA-IR < 2.38 group in the right and left ovary, respectively, before and after metformin treatment (P < 0.05). PSV for both ovaries were positively correlated with HOMA scores before and after metformin treatment [(r = 0.713, P = 0.000; r = 0.617, P = 0.04 and r = 0.635, P= 0.03; r = 0.483, P = 0.031 respectively]. Conclusion  Metformin treatment affected ovarian stromal blood flow in PCOS patients.     

The significance of pelvic floor support on the pelvic floor muscle functions of women with lower urinary tract symptoms

ObjectiveTo explore the significance of pelvic organ prolapse (POP) on pelvic floor muscle (PFM) function among women with lower urinary tract symptoms (LUTS).Materials and methodsFour-dimensional ultrasound data of 577 women with LUTS were retrospectively analyzed. The bladder neck and genital hiatus were assessed during resting, coughing, and squeezing. The bladder neck location, genitohiatal size, and genitohiatal location were evaluated with bladder neck distance (BNd) and bladder neck angle (BNa), genitohiatal dimension (GHd) and genitohiatal area (GHAR), and genitohiatal angle (GHa), respectively.ResultsCompared with women without POP (n = 306), women with POP (n = 271) exhibited higher rates of levator complete avulsion (6.5% vs. 40.2%, P < 0.001), shorter BNd (2.84 ± 1.56 cm vs. 2.45 ± 0.45 cm, P = 0.018), larger BNa (92 ± 15° vs. 101 ± 21°, P < 0.001), longer GHd (5.25 ± 0.72 cm vs. 5.60 ± 0.87 cm, P < 0.001), larger GHa (141 ± 10° vs. 145 ± 9°, P = 0.004), and larger GHAR (20.0 ± 4.7 cm² vs. 24.2 ± 5.6 cm², P < 0.001) during resting. Fewer women with POP were able to maintain stable bladder neck location (79.5% vs. 65.5%, P < 0.001), genitohiatal size (60.7% vs. 51.9%, P = 0.042), and genitohiatal location (61.6% vs. 52.8%, P = 0.044) following coughing. Fewer women with POP were capable of squeezing (77.8% vs. 58.3%, P < 0.001).ConclusionAmong women with LUTS, the presence of POP is associated with weaker resting, involuntary, and voluntary PFM functions.     

Increment of absolute neutrophil count in the third trimester and increased risk of small-for-gestational-age birth: Hirakata Risk Associated with Pregnancy Assessment Research (HIRAPAR)

Objective

Velocity vector imaging (VVI) is widely used to quantify cardiac mechanical deformation. This study sought to determine whether VVI could be used to evaluate the stiffness of maternal peripheral arteries in women with pre-eclampsia.

Study design

Twenty-four women with pre-eclampsia and 34 normotensive pregnant women were recruited. Longitudinal and circumferential peak velocity, strain and strain rate of the right common carotid artery (CCA) were measured. All measurements were averaged from three consecutive cardiac cycles and expressed as mean ± standard deviation.

Results

Longitudinal velocity, strain and strain rate of the anterior and posterior walls of the CCA were significantly lower in women with pregnancy-induced hypertension compared with normotensive pregnant women [velocity: 0.22 ± 0.09 cm/s vs 0.29 ± 0.09 cm/s (p < 0.01) and 0.24 ± 0.10 cm/s vs 0.34 ± 0.13 cm/s (p < 0.01); strain: 8.50 ± 4.92% vs 12.2 ± 6.21% (p < 0.01) and 10.11 ± 5.02% vs 14.21 ± 6.48% (p < 0.05); strain rate: 1.62 ± 1.14 s^-1 vs 2.24 ± 1.13 s^-1 (p < 0.05) and 1.91 ± 0.99 s^-1 vs 2.45 ± 0.97 s^-1 (p < 0.05)]. Similar results were also found for circumferential velocity, strain and strain rate of the anterior and posterior walls, and the interior and exterior lateral walls of the CCA.

Conclusions

Stiffness of the maternal CCA was significantly greater in women with pre-eclampsia compared with normotensive pregnant women. VVI may have potential for quantitative assessment of vascular mechanical deformation in the clinical setting.     

Gynäkologie und Geburtshilfe – gestern, heute, morgen

Ohne ZusammenfassungVortrag im Klinikum Krefeld anlässlich der Verabschiedung von Prof. Dr. Jörg Baltzer, 18.10.2006.

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Impact of treatment modality on overall survival in women with advanced endometrial cancer: A National Cancer Database analysis

ObjectiveTo evaluate overall survival (OS) in women with advanced endometrial cancer (EC) following chemotherapy alone (CT), neoadjuvant chemotherapy and interval debulking surgery (NACT + IDS) or primary cytoreductive surgery and chemotherapy (PCS + CT).MethodsThe National Cancer Database (NCDB) was queried for patients with stage III/IV EC from 2004 to 2015. Univariable and multivariable Cox proportional hazards analyses assessed the impact of treatment modality upon OS.ResultsOf 48,179 women identified, 5531 received CT (11.5%), 2614 NACT + IDS (5.4%) and 40,034 PCS + CT (83.1%). Median OS was 11.1 months for CT, 25.1 months for NACT + IDS and 60.9 months for PCS + CT (p < 0.001). On multivariate analysis, NACT + IDS (HR 0.44 (0.40, 0.49); p < 0.001) and PCS + CT (HR 0.32 (0.30, 0.35); p < 0.001) were associated with improved OS vs. CT alone. Age, African American race, income, higher Charlson comorbidity index and grade were predictors of worse OS (p < 0.001). On subgroup analysis by stage (III/IV) and histology (Type I/II), PCS + CT improved OS for all patients, compared to NACT + IDS (p < 0.001) and CT (p < 0.001). NACT + IDS was associated with improved OS vs. CT in stage III type I (HR 0.50; 95% CI 0.38, 0.67; p < 0.001), stage IV type I (HR 0.43; 95% CI 0.35, 0.52; p < 0.001), and stage IV type II EC (HR 0.43; 95% CI 0.36, 0.51; p < 0.001), but not stage III type II EC (HR 0.76; 95% CI 0.56, 1.03; p = 0.08).ConclusionsIn women with advanced EC, PCS + CT is associated with improved OS compared to NACT + IDS or CT alone, regardless of stage or histology. Additionally, NACT + IDS is associated with superior OS in stage III type I and all stage IV EC compared to CT alone. Where feasible, surgery should be incorporated into treatment planning in women with advanced EC.     

Aromatase (CYP19) gene variants influence ovarian response to standard gonadotrophin stimulation

Purpose

The association of cytochrome P450 aromatase gene CYP19(TTTA)_n polymorphism with ovarian response to FSH stimulation was explored.

Methods

Three hundred women undergoing medically assisted reproduction and 300 women with at least one spontaneous pregnancy participated in the study. CYP19(TTTA)_n polymorphism was genotyped, while serum hormones were determined. During oocyte retrieval, the follicular size, the follicle and oocyte numbers were recorded.

Results

Six CYP19(TTTA)_n alleles with 7 to 12 repeats were revealed. Women homozygous for long CYP19(TTTA)_n alleles presented with lower serum FSH levels at the third day of the menstrual cycle (p < 0.001) and higher large follicle numbers (p < 0.01), compared to women homozygous for short CYP19(TTTA)_n alleles. The CYP19(TTTA)₇ allele was associated with higher serum FSH levels (p < 0.003), with lower total follicle (p < 0.02) and large follicle numbers (p < 0.03), while CYP19(TTTA)₇ allele-carriers presented more frequently with small follicles than CYP19(TTTA)₇ allele-non carriers (p < 0.01).

Conclusions

CYP19 genetic variants were associated with ovarian reserve and response to standard gonadotrophin stimulation of women undergoing in vitro fertilization.     

Ernährungsfragen unter besonderer Berücksichtigung von Schwangerschaft und Kinderwunsch

Zusammenfassung  In der Schwangerschaft muss über eine insgesamt bedarfsgerechte Ernährung hinaus v. a. auf die Versorgung mit Vitaminen und Mineralstoffen geachtet werden. Dies gilt insbesondere für Folsäure, Eisen und Jod, da Mängel zu gesundheitlichen Störungen führen können. Im vorliegenden Beitrag werden für eine weibliche Befragtengruppe 6 Ernährungstypen vorgestellt und beschrieben, wie sich diese im Ernährungsverhalten unterscheiden. Auf der Grundlage der Daten des 7-Tage-Ernährungsprotokolls der Deutschen Gesellschaft für Ernährung wird untersucht, ob die Zugehörigkeit zu einem bestimmten Ernährungstyp zu einer unterschiedlichen Versorgung mit Vitaminen und Mineralstoffen führt und die Zugehörigkeit zum gesunden Ernährungstyp mit einer gesünderen Ernährung verbunden ist. Es wird belegt, dass dies für die große Mehrzahl der Mikronährstoffe tatsächlich der Fall ist. Dies gilt jedoch für Folsäure, Eisen, Jod und partiell Kalzium weder vor und schon gar nicht in der Schwangerschaft in relevantem Umfang. Gezielte Ernährungsempfehlungen sind so v. a. für jüngere Frauen erforderlich, die eine Schwangerschaft nicht ausschließen und sich nicht dem gesunden Ernährungstyp zuordnen. Praktische Medien und Instrumente für die Praxis des Frauenarztes werden vorgestellt.

Human Papillomavirus-Related Gynecologic Neoplasms: Screening and Prevention

The recent recognition of oncogenic human papillomavirus (HPV) as a key component of female lower genital tract malignancies has led to significant changes in many screening and prevention guidelines for cervical cancer, and, combined with the advent of vaccination, will likely have sweeping repercussions on the incidence of cervical, vulvar, and vaginal carcinoma. This article focuses on the specific principles of cancer screening and prevention with an emphasis on HPV-mediated disease.Key words: Human papillomavirus, Cervical cancer, Vulvar cancer, Vaginal cancer, Screening programsOver the past 25 years, the human papillomavirus (HPV) has been identified as the etiologic agent driving much of the neoplasia observed in the lower female reproductive tract (Table 1).^1–3 HPV has been implicated in close to 100% of cervical cancers,⁴ up to 70% of squamous cell carcinomas (SCCs)⁵ of the vulva, and 60% of SCCs of the vagina.⁶ Given the high worldwide prevalence of preinvasive and invasive disease, cervical cancer has been the historical focus of extensive screening programs that began with the Papanicolaou test, and now continue with the emergence of vaccines that target the oncogenic strains of HPV known to cause the majority of cervical dysplasia and carcinoma. This recent recognition of oncogenic HPV as a key component of female lower genital tract malignancies has led to significant changes in many screening and prevention guidelines for cervical cancer, and, combined with the advent of vaccination, will likely have sweeping repercussions on the incidence of cervical, vulvar, and vaginal carcinoma.

Table 1

Prevalence of HPV Infection by Lower Genital Tract Dysplasia and Malignancy

A case–control study of placental lesions associated with pre-eclampsia

ObjectiveTo investigate gross and microscopic placental lesions associated with pre-eclampsia and to determine which lesions are most strongly linked to serious pregnancy complications.MethodsA retrospective case–control study of 173 placentas from women with pre-eclampsia and 173 placentas from healthy normotensive women was conducted.ResultsThe mean placental weight in the pre-eclampsia group was lower than that recorded for the control group (280 g vs 360 g; P < 0.001). Infarcts (65.9% vs 13.2%; P < 0.001) and placental abruption (P < 0.001) were most frequent among women with pre-eclampsia. Microscopic findings showed the following lesions to be associated with pre-eclampsia: hypermature villi, defined by absence of intermediate villi (72% vs 16%; P < 0.001), excessive syncytial knots (90% vs 9%; P < 0.001), decidual vasculopathy (51% vs 8%; P < 0.001), villous fibrosis (6% vs 0%; P < 0.001), erythroblastosis (11% vs 4%; P < 0.01), and avascular terminal villi (9% vs 3%; P < 0.05). Increased syncytial knots, infarcts, basal decidual vasculopathy, hypermature villi, and placental erythroblastosis were still associated with pre-eclampsia after logistic regression modeling.ConclusionPlacental lesions most strongly associated with pre-eclampsia were all causes or expressions of placental hypoxia or ischemia, which appears as the primary mechanism of pre-eclampsia.     

Placental mRNA expression of angiopoietins (Ang)-1, Ang-2 and their receptor Tie-2 is altered in pregnancies complicated by preeclampsia

Objective

To investigate the placental expression of angiopoietin (Ang)-1, Ang-2 and their receptor, Tie-2, in preeclampsia (PE) with or without intrauterine growth restriction (IUGR).

Methods

Case-control study including placentas from 28 PE pregnancies, 30 PE-IUGR pregnancies and 40 controls. The expression status of the genes was evaluated by quantitative real-time PCR.

Results

In both PE and PE-IUGR groups, compared to the control group, there was significantly higher expression of Ang-2 (p < 0.001) and Tie-2 (p = 0.008) and lower expression of Ang-1 (p = 0.001). The magnitude of the difference was similar for Ang-1 for both groups, whereas the magnitude of the differences was higher for Ang-2 and Tie-2 in PE-IUGR group compared to controls. Ang-2 and Tie-2 were correlated in both PE (r = 0.8602, p < 0.001) and PE-IUGR (r = 0.6342, p < 0.001) groups. In PE-IUGR group, Ang-1 was associated to Ang-2 (r = 0.3458, p = 0.0452) and Tie-2 (r = 0.4448, p = 0.0084). Log₁₀Ang-1 but not Ang-2 was gestational age dependent (R2 = 0.40, p < 0.001). After conversion in Multiples of the Median (MoM) log₁₀ MoM Ang-1 was reduced in the PE group (mean = −0.8181, p < 0.001) and the PE-IUGR group (mean = −1.2583, p < 0.001) compared to control group (mean = −0.0924).

Discussion

We have demonstrated increased placental expression of Ang-2 and Tie-2 along with lower expression levels of Ang-1 in pregnancies with PE and PE-IUGR.

Conclusion

The angiopoietin axis seems to be disrupted in PE pregnancies. Whether the results of this study represent the angiogenic imbalance observed in PE pregnancies or they are part of the pathophysiology of this condition has to be further investigated.     

Music as a Therapeutic Intervention on an Inpatient Neuroscience Unit

The purpose of this study was to determine the effect of a music intervention (MI) on physiological parameters, pain and mood states in the neuroscience patient. This study enrolled and randomized subjects to 1of 2 groups, usual care (UC) group (n = 29) or UC plus MI (n = 24). Data collected were physiologic parameters, pain and mood states pre and post a 30 min MI with UC compared to UC. The sample was 16 males/37 females, mean age of 55.8 years, with similar baseline characteristics. There were significant reductions in heart rate (t = ?2.1, p < 0.04), respirations (t = ?3.4, p < 0.001), perceived anxiety (t = ?4.1, p < 0.000), depression (t = ?4.3, p < 0.000), and total mood score (t = ?4.1, p < 0.000) in subjects who received UC plus MI compared to UC. The inclusion of MI as a therapeutic intervention for neuroscience patients appears to decrease the emotional burden of hospitalization.     

Severity of pain and circadian changes in uterine artery blood flow in primary dysmenorrhea

Objective  To investigate the severity of pain and circadian changes in uterine artery blood flow in primary dysmenorrhea cases. Materials and methods  The study included 27 cases diagnosed as primary dysmenorrhea and 25 individuals who had no dysmenorrhea complaint. Bilateral uterine artery systole/diastole rates (S/D), pulsatility indices (PI) and resistance indices (RI) of all cases were measured using transvaginal colour Doppler at 12.00–02.00 p.m. and 12.00–02.00 a.m. Severity of pain was evaluated in dysmenorrhea cases at the same hours using a verbal pain assessment scale. Findings  Doppler measurements of dysmenorrhea cases conducted at 12.00–02.00 p.m. showed right uterine artery S/D: 3.37 ± 0.26, RI: 0.73 ± 0.07, PI: 2.38 ± 0.34 and left uterine artery S/D: 3.33 ± 0.37, RI: 0.74 ± 0.14, PI: 2.41 ± 0.15, while measurements carried out at 12.00–02.00 a.m. showed right uterine artery S/D: 3.88 ± 0.12, RI: 0.87 ± 0.14, PI: 2.94 ± 0.21 and left uterine artery S/D: 3.90 ± 0.27, RI: 0.92 ± 0.12, PI: 2.93 ± 0.21. Comparisons revealed significantly higher Doppler indices at night (P < 0.05) than in the day in dysmenorrhea cases. There was not any significant circadian difference in individuals who did not have dysmenorrhea (P > 0.05). Pain score in the verbal pain assessment of dysmenorrhea cases was found 3.6 ± 1.4 in the day and 5.8 ± 1.7 at night. The difference was found significant (P < 0.05). Conclusion  Uterine artery blood flow is reduced at night in dysmenorrhea cases. In correlation with this, the cases feel more pain at night. Our results may be important on the planning of working hours and their quality of life.     

Randomized study of bipolar vessel sealing system versus conventional suture ligature for vaginal hysterectomy

Objective

This study was undertaken to compare the use of bipolar vessel sealing system (BVSS) with conventional suture ligature in vaginal hysterectomy (VH) on a non-prolapsed uterus.

Study design

Women referred for VH for uterine myoma were randomized to BVSS (n = 45) or conventional suture ligature VH (n = 45). Exclusion criteria were uterine prolapse and indication associated surgical procedures. Main outcome measures were operative time, blood loss, hospital stay, pain status, peri and post-operative complications. Data of patients were collected prospectively. Statistical analysis was performed using chi-square and Student's t-test as appropriate.

Results

There were no differences in patients’ mean age, parity and uterine size between groups. Patients in the BVSS group had a significantly reduced operating time (29.2 ± 2.1 min vs. 75.2 ± 5 min; p < 0.001), operative blood loss (84 ± 5.9 mL vs. 136.4 ± 89.1 mL; p = 0.001), requirement of surgical sutures (1.2 ± 0.6 units vs. 7.4 ± 0.3 units; p < 0.001), pain status (1.6 ± 0.4 vs. 3.6 ± 0.4; p < 0.001) and hospital stay (25.6 ± 0.9 h vs. 33.2 ± 1.7 h; p < 0.001) compared to the control group. The overall complication rate in the study was 7.8% (7/90), and did not differ between patients of the BVSS and control group.

Conclusion

Bipolar vessel sealing for vaginal hysterectomy appears to be an effective and safe haemostatic control method, with reduced operating time, peri-operative blood losses, post-operative pain and hospital stay.     

Preoperative Risk Stratification of Adnexal Masses: Can We Predict the Optimal Surgical Management?

Study ObjectiveTo characterize preoperative risk stratification with aim of identifying the accurate surgical approach of benign and malignant adnexal masses in pediatric patients.DesignA retrospective chart review of all cases of adnexal masses surgically managed between January 2001 and December 2006.SettingThe Hospital for Sick Children, Toronto, Canada.Participants129 cases of 126 pediatric and adolescent patients who underwent operative management of their adnexal masses.Main Outcome MeasuresUltrasonographic characteristics (cyst size and character), surgical approach (laparoscopy vs laparotomy) and method of cyst removal (cystectomy vs oophorectomy). Data was assessed with a Fisher Exact test where appropriate (P < .05).ResultsMalignancies were more frequently treated by laparotomy (n = 14, 98.6%, P < .001), and benign cases by laparoscopy (n = 78, 97%, P < .001). On ultrasonography, malignant masses were more often complex (n = 16, 100%, P = .006) and ≥8 cm (n = 16, 100%, P < .001) than benign masses (≥8 cm n = 60, 53%, complex n = 76, 67%). Combining ultrasonographic measurements of ≥8 cm and complexity identified 100% of malignant masses (n = 16) and 36% of benign masses (n = 41, P < .001, PPV = 37.1, NPV = 100%). Additional imaging including CT/MRI was ordered by pediatric surgeons (n = 17, 77%) more often than pediatric gynecologists (n = 44, 41%, P = .002). Furthermore, pediatric surgeons managed adnexal masses by oophorectomy (n = 12, 55%) more often as compared to pediatric gynecologists (n = 19, 18%, P < .001).ConclusionUsing preoperative characteristics of complexity and ≥8 cm reduces the number of benign masses treated with laparotomy while ensuring malignant masses are managed with an open approach.     

Intérêt d’un combipatch de thrombine et de fibrinogène dans la prévention des lymphocèles après curage axillaire

ObjectiveTo evaluate the effect of combipatch TachoSil^® in the prevention of seromas after axillary dissection in local breast cancer.Patients et méthodesA retrospective, case-control study conducted between January 2007 and December 2009, in two departments of Obstetrics and Gynecology of the AP–HP. Sixty-six patients (45 in the control group and 22 in the group TachoSil^®) who have undergone an axillary dissection alone, with establishment of a redon or with lumpectomy, were included. The total amount of lymph drained during the stay, the number of days of drainage, duration of hospitalization, the number of lymphoceles and the number of retrievals performed at the waning of hospitalization were collected.ResultsThe population was similar in age, body mass index (BMI), clinical and pathological data. There was no significant difference in terms of total volume of lymph drained (268.2 ± 220.7 mL without TachoSil^® and 228.6 ± 128.8 mL with TachoSil^®, P = 0.89) and the number of days of drainage (3.9 ± 1.6 days without TachoSil^® and 3.1 ± 0.9 days with TachoSil^®, P = 0.10). The duration of hospitalization was significantly higher in the group TachoSil^® (5 ± 1.6 days with TachoSil^® and 3.8 ± 1.1 days without TachoSil^®, P = 0.006).ConclusionThis study shows no benefit of combipatch (TachoSil^®) in prevention of seromas after axillary lymph node dissection. A randomized study with large effective is necessary.     

Comparison of the inhibitory effects of cromakalim and pinacidil (potassium channel openers) with those of oxybutynin on stimulated guinea pig and rabbit detrusor muscle strips

To compare the inhibitory effects of a new group of smooth muscle relaxants, the potassium channel openers cromakalim and pinacidil, with those of oxybutynin on detrusor muscle stimulation in animals. Detrusor strips of guinea pigs (n=16) and rabbits (n=20) were mounted in organ bath for recording of isometric tension. α,β-methylene ATP (10^–7, 10^–6, 10^–5 M), carbachol (10^–6, 10^–5, 3×10^–5 , 5×10^–5 M) and transmural electrical-field stimulation (TES) were applied and concentration-response curves in the absence or presence of cromakalim (10^–6 , 10^–5 M), pinacidil (10^–5 , 5×10^–5 M) and oxybutynin (10^–5, 5×10^–5 M) were generated. All curves were displaced to the right in a concentration-dependent manner. The order of potency of inhibition was as follows: α,β-methylene ATP (pinacidil>oxybutynin>croma- kalim in guinea pigs; pinacidil>cromakalim>oxybutynin in rabbits); TES (pinacidil>cromakalim>oxybutynin in guinea pigs; cromakalim>oxybutynin>pinacidil in rabbits); carbachol (oxybutynin>pinacidil>cromakalim in guinea pigs; oxybutynin>cromakalim>pinacidil in rabbits). Cromakalim and pinacidil mainly inhibited purinergic-induced (α,β-methylene ATP and TES) detrusor contractions. Received: 9 November 2000 / Accepted: 25 November 2000