Hand-held Doppler examination missed LSV or SSV incompetence in 11 per cent of legs, but these included cases with short-duration and low-velocity reflux of dubious clinical importance.
Pressure in the vagina as well as within the bladder and rectum was measured during urodynamic investigations. Rectal pressure is normally used to represent changes in abdominal pressure which, when subtracted from the total bladder pressure, provides a method of assessing detrusor function. This study showed that vaginal pressure represented changes in abdominal pressure more accurately and consistently than did rectal pressure, and the vagina is therefore recommended as an alternative site in conducting urodynamic studies.
The glomerular basement membrane (GBM) is an important component of the filtration barrier that is the glomerular capillary wall. Previously GBM permeability has been investigated only under static pressures and often within a supraphysiological range. We used Matrigel as a model of GBM and formed membranes at the base of a filtration chamber. We measured membrane permeability under static and dynamic pressures. Matrigel membranes were size and charge selective toward neutrally and negatively charged dextrans. Their permeability (as measured by hydraulic conductivity) was found to decrease from 1.61 ± 0.06 to 0.75 ± 0.07 × 10−6cm ⋅ s−1 ⋅ cmH2O−1as static pressure increased from 6 to 78 cmH2O, an effect attributed to membrane compression. In comparison to static pressure, sinusoidal pressure waves with a mean pressure of 50 cmH2O decreased membrane permeability, e.g., fluid flux was reduced by a maximum of 2% to a value of 5.47 ± 0.38 × 10−5 cm/s; albumin clearance was reduced by a maximum of 5.2% to a value of 9.63 ± 1.06 × 10−6ml ⋅ cm−2 ⋅ s−1. Such changes were affected by the frequency of pressure wave application and could be attributed to a switching on and off of the membrane compression effect.
There should be further systematic laboratory and clinical research before AFCs can be recommended for routine clinical use. We would recommend that a professional worldwide multidisciplinary scientific society, such as the International Continence Society, should work with manufacturers and regulatory bodies to ensure that this urodynamic method is properly scientifically evaluated, in the wider interests of patient safety.
Selective use of HHD can avoid duplex imaging for many patients, with a low failure rate for detecting correctable venous reflux. Observed variations between individuals and units in results of HHD and duplex imaging have implications for the increasing use of duplex by clinicians.
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