Counting the cost of treating benign prostatic hyperplasia.
Explore the source record for details and available documents.
Costs and Cost Analysis↗
Biomedical subjects
C L Foley
Publications and source records attributed to C L Foley.
A large prostate at radical retropubic prostatectomy does not adversely affect cancer control, continence or potency rates.
OBJECTIVES: To determine the effect of a large prostate at radical retropubic prostatectomy (RRP) on the pathological outcome, biochemical recurrence rates, potency and continence. PATIENTS AND METHODS: From a database of 440 patients treated with RRP, retrospective information was obtained on prostate weights, patient and tumour characteristics, and follow-up. Potency and continence after RRP was obtained using a self-reported validated questionnaire. Patients with prostates of > 75 or < or = 75 g were compared. RESULTS: The median (range) prostate size was 87 (76-182) and 42 (4.1-75) g in the two groups. The response rate to the questionnaire was 78% (344 men). Patients with prostates of > 75 g were older, with a median (range) age of 65 (51-74) years, than the other group, at 61 (40-76) years (P = 0.01), and had higher initial prostate-specific antigen (PSA) levels, at 9.6 (3.4-37.8) and 7.6 (0.1-30.0) ng/mL, respectively (P = 0.001). Tumours within larger prostates were of a lower stage (P = 0.035), lower Gleason grade (median 6 and 7, P = 0.015), of smaller volume (median 1.0, 0.1-12.4; and 1.5, 0.1-21.1 mL; P = 0.04) and more often 'clinically insignificant' (23% and 6%, P = 0.001). There was no difference in the number or distribution of positive surgical margins. For a limited median follow-up of 20-25 months, patients with prostates of > 75 g were less likely to have biochemical recurrence (5% vs 24%, P < 0.001). Potency and continence rates were similar between the groups. CONCLUSIONS: Prostate size at RRP does not affect the risk of impotence or incontinence afterward. A prostate of > 75 g is associated with a lower likelihood of PSA-relapse, potentially as a result of lead-time bias. While an enlarged prostate may contraindicate other potentially curative cancer treatments, the outcomes of RRP appear to be unaffected.
Adult↗
Testicular torsion unravelled.
Testicular torsion is a true vascular emergency-prompt diagnosis and surgical management is critical. If treatment is not instigated within 4-6 hours of the onset of pain, irreversible testicular infarction may result, necessitating orchidectomy. This review presents the key features, management principles and medicolegal considerations of this serious condition.
Diagnosis, Differential↗
Not all rods are Harrington - an overview of spinal instrumentation in scoliosis treatment.
BACKGROUND: Scoliosis is a multiplanar spinal deformity, which has been treated in the past with spinal fusion and cast application, starting in the early part of this century. In the last 30 years, Paul Harrington successfully introduced spinal instrumentation for scoliosis. Harrington instrumentation has had a large impact on the treatment of scoliosis. Currently, there are many different instrumentations available for the treatment of scoliosis. Indications differ for the use of these systems. Appreciation of spinal instrumentation is essential to treatment of the patient with scoliosis. Post-operative roentgenographic studies are better understood when the interface between instrumentation and the spine is understood. MATERIALS AND METHODS: Distinguishing characteristics between some of the more common instrumentations are noted. There continues to be a proliferation of spinal instrumentation systems. Roentgenograms and spinal models are used to explain how some of the instrumentation systems differ and how they interface with the spine. CONCLUSION: An overview of spinal instrumentation in scoliosis treatment will allow better understanding of the purposes of the hardware and how it relates to the spine.
Child↗
Nephroblastomatosis and Wilms' tumor. Clinical experience and management of seven patients.
Nephroblastomatosis is an uncommon abnormality believed to represent the persistence of embryonal renal tissue. Its association with simultaneous or eventual Wilms' tumor has led to the speculation that it is a premalignant lesion. The accumulated clinical experience with this process and its progression to Wilms' tumor in three of seven individuals is discussed. It is concluded that conservative tissue sparing surgery, chemotherapy, and ultrasonographic follow-up are the approaches most appropriate for the management of these difficult patients.
Adolescent↗
A study of blood cross-matching requirements for surgery in gynecological oncology: improved efficiency and cost saving.
The objective of this study was to design and implement a maximum surgical blood order schedule (MSBOS) within a specialist gynecological oncology department in a tertiary referral center and evaluate its impact on the cross-match to transfusion ratio (CTR). A retrospective case note audit was undertaken to identify common operations performed within the unit and their transfusion requirements. The efficiency of blood usage was assessed using the CTR, and an MSBOS was devised and implemented. A prospective audit of preoperative blood cross-matching and subsequent blood usage was then performed for consecutive elective operations in the unit, to assess the effect of the MSBOS. The retrospective study of 222 cases demonstrated a CTR of 2.25 equivalent to 44% usage of cross-matched blood. Ninety two percent of operations performed within the unit could be incorporated into an MSBOS. The prospective study of 207 cases demonstrated a significantly reduced CTR of 1.71 or 59% blood usage (chi2 = 12.4, P < 0.001). This equates to a saving of 102 units of blood over the 15 months prospective audit. Protocol adherence was 77%. No patient was adversely affected by the adoption of the MSBOS. We conclude that an MSBOS can be safely introduced into a gynecological oncology department resulting in significant financial savings.
Blood Banks↗