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Biomedical subjects

C S Powell

Publications and source records attributed to C S Powell.

At least 19 recordsLinked to original sources
PubMed2000

Considerations in the management of aneurysms of the superior mesenteric artery.

Aneurysms of the superior mesenteric artery (SMA) are rare, accounting for 5.5% of all splanchnic aneurysms and <0.5% of all intraabdominal aneurysms. Previous reports have characterized these aneurysms among splanchnic artery aneurysms. However, these aneurysms are quite different in terms of etiology, presentation, and treatment, and their independent consideration is warranted. We report a patient with a traumatic SMA aneurysms who was successfully treated with surgical resection and distal revascularization. We also present an alternative technique of retrograde aorto-SMA bypass using autologous vein that prevents kinking. Also included is a review of the recent literature as it pertains specifically to SMA aneurysms.

Aortic Dissection↗
PubMed2000

Ureteroscopic endopyelotomy with the Holmium:YAG laser. mid-term results.

OBJECTIVE: Various modalities ranging from acucise balloon to endoincision with electrocautery, cold knife, and lasers have been used to treat ureteropelvic junction obstruction (UPJO). We assessed the intermediate effectiveness of endopyelotomy with the holmium(Ho):YAG laser. PATIENTS AND METHODS: Between November 1994 and May 1998, 20 patients with 16 primary and 4 secondary symptomatic UPJO were treated. All patients were evaluated clinically and radiologically before and after the procedure at 3 months, and yearly thereafter. The mean follow-up was 34 months (12-38 months). RESULTS: A total of 22 procedure were performed on 20 patients with an average operating time of 44.3 min and mean hospital stay of 1.9 days. All patients were stented after the procedure for 6 weeks. Complication included urinoma (1) and guidewire fracture in 1 patient. 15 patients had a successful outcome determined by a diuretic renography and/or Whitaker test. Three patients with poor preoperative renal function (<25%) had an unsatisfactory outcome. There were 2 failures and they were treated with nephrectomy (1) and open pyeloplasty (1). CONCLUSIONS: A controlled, precise, safe and almost 'bloodless' endopyelotomy can be performed with the holmium laser. Success rate tends to be poor in patients with poor renal function.

Adult↗
PubMed1999

Bifurcated endovascular grafting for abdominal aortic aneurysm.

Endovascular grafting represents a minimally invasive approach to prosthetic aortic grafting for abdominal aortic aneurysms (AAA). We reviewed our initial experience with a bifurcated endovascular graft that shares with conventional grafts the characteristics of discrete transaortic fixation and unitary unsupported woven polyester construction. Twenty-eight patients (26 male, 2 female; age: 58-93) with infrarenal aortic aneurysms between 41 and 82 mm in greatest diameter (x = 55.4 mm) underwent bifurcated endovascular grafting (Guidant/EVT, Menlo Park, CA) over an 18-month period. We concluded that bifurcated endovascular grafting with the EVT(R) device provides reliable and reproducible aneurysm exclusion with short hospital recovery and low morbidity.

Aged↗
PubMed1999

Autologous superficial femoral vein for aortic reconstruction in infected fields.

Autogenous reconstruction is one option available for patients with aortic graft infection or mycotic aneurysms. We reviewed our recent institutional experience with all patients undergoing aortic reconstruction using autologous superficial femoral vein (SFV). Between February 1995 and November 1997, eight patients (five with prosthetic aortic graft infection and three with mycotic aneurysms, including one ruptured mycotic aneurysm) underwent single-stage aortic reconstruction using autologous SFV. Therapy for graft infection included graft excision and replacement with aortobifemoral or aortofemoral (with subsequent cross femoral) grafts fashioned from the SFV. The two patients undergoing elective repair of mycotic aneurysms were treated with extensive SFV patches, and the patient with a ruptured mycotic aneurysm underwent SFV tube grafting. Autogenous reconstruction of the aorta using the SFV in infected fields shows promise for salvage of life and limb during early experiences and short-term follow-up. Morbidity and mortality rates compare favorably with those from existing series, reconstruction is anatomic, and reinfection potential is low. Long-term follow-up and more extensive experience with this technique are needed to establish its role relative to other conventional methods.

Aged↗
PubMed1999

Telemedicine and endovascular aortic grafting.

Endovascular aortic grafting represents a minimally invasive approach to aortic aneurysm repair. The technique requires a variety of new skills and extensive training. Telemedicine enhances mentoring and technical support for surgeons performing the technique.

Aortic Aneurysm↗
PubMed1998

Ureteroscopic holmium lasertripsy for ureteric stones. Initial experience.

The clinic benefits of the Holmium: YAG laser include a pronounced haemostatic effect, fibreoptic delivery system and a wide range of power-setting options. We review our initial experience in treating 48 patients with ureteric stones. Stones were located in the upper, middle and lower ureter in 27%, 21% and 52% of patients respectively. The Holmium laser successfully fragmented all calculi and there were no major complications. We have found the Holmium laser to be a safe, effective and reliable alternative for the management of urolithiasis.

Adult↗
PubMed1998

Nephroblastoma in a 76-year-old male.

Nephroblastoma is an infantile neoplasia with a low incidence in adults. A case of Wilms' tumour in a 76-year-old male is reported. In a literature review the current status of knowledge in the geriatric population is discussed.

Age Factors↗
PubMed1998

Transurethral incision of the prostate using the holmium:YAG laser: a catheterless procedure.

PURPOSE: Transurethral incision of the prostate is a well established technique for relieving bladder outflow obstruction caused by prostate glands less than 30 gm. We present data showing that the holmium:YAG laser can prevent postoperative catheterization without compromising the outcome of surgery. MATERIALS AND METHODS: We prospectively followed 100 men an average of 62 years old with symptomatic bladder outflow obstruction and a benign prostate gland less than 30 gm. clinically in whom serum prostate specific antigen was less than 4 microg./l. They were assessed using International Prostate Symptom Score, urinary flow rate, post-void residual estimation and sexual function questionnaires preoperatively, and 6 weeks, and 1 and 2 years postoperatively. With the patient under general anesthesia a single incision was made from the ureteral orifice to the verumontanum and out to fat using holmium:YAG laser energy transmitted through a 400 nm. fiber sheathed in a ureteral catheter. RESULTS: A total of 97 patients voided without postoperative catheterization. Average International Prostate Symptom Score decreased from 19.2 to 3.7 at 6 weeks and it remained improved at 2 years (average 3.5). Reciprocal results were achieved with improvement in average urinary flow rate from 9.79 to 19.23 and 18.27 ml. per second at 6 weeks and 2 years, respectively. Residual urine measurement decreased from 133.6 ml. preoperatively to 27 and 10 ml. at 6 weeks and 2 years, respectively. All 77 patients potent preoperatively remained so, although retrograde ejaculation developed in 8. CONCLUSIONS: The holmium:YAG laser allows transurethral prostatic incision to be performed without the need for postoperative catheterization while maintaining efficacy.

Adult↗
PubMed1998

Guidewire fragmentation during holmium:YAG laser endopyelotomy.

A guidewire fracture is a rare complication of laser surgery. We report that this rare complication occurred during a retrograde endoureteropyelotomy with the holmium:YAG laser. No data are available about the safety of commonly used guidewires. A comparative in vitro study was performed with two types of guidewires to assess their resistance. At all energy levels tested, a Teflon-coated guidewire performed best in the present safety test.

Aged↗
PubMed1997

Daycase transurethral incision of the prostate using the holmium: YAG laser: initial experience.

OBJECTIVE: To ascertain whether the holmium: YAG laser can be used for transurethral incision of the prostate (TUIP), without the need for post-operative catheterization. PATIENTS AND METHODS: The study comprised 100 men with symptomatic bladder outlet obstruction and clinically benign glands (< 30 g). The International Prostate Symptom Score (IPSS), flow rates and post-void residual urine volume were measured before and 6 weeks after surgery. The first 22 patients were admitted overnight for observation, but the remaining 78 patients were discharged on the day of the procedure, once they had successfully voided. RESULTS: Ninety-seven men voided successfully on the day of the procedure. The mean IPSS, flow rate and residual urine volume were all significantly improved at the time of review. Six patients developed a urinary tract infection post-operatively and eight men reported retrograde ejaculation. CONCLUSION: The holmium: YAG laser facilitates a bloodless TUIP thus avoiding catheterization, allowing the procedure to be carried out as a day case.

Adult↗
PubMed1997

Emphysematous cystitis.

A case of emphysematous cystitis in a diabetic female is described. Its presentation is non-specific and the prognosis depends on then degree of aggressiveness at presentation. Early diagnosis and aggressive medical and surgical management of gas-forming organisms are vital.

Aged↗
PubMed1997

Retrograde endoureteropyelotomy with the holmium:YAG laser. Initial experience.

OBJECTIVE: To evaluate the safety and efficacy of the holmium:YAG laser in the management of pelviureteric junction (PUJ) obstruction. PATIENTS AND METHODS: Between November 1994 and February 1996, 8 patients with 5 primary and 3 secondary PUJ obstructions underwent retrograde ureteroscopic holmium:YAG laser endopyelotomy. A 320- to 365-micron (Slimline, Coherent) fibre was used to deliver the laser energy. A posterolateral endopyelotomy was performed under visual monitoring. All patients had a ureteral stent left in place postoperatively for 6 weeks and a renogram was performed after 3 months. The mean follow-up was 12.4 months (3-24 months). RESULTS: Almost bloodless, accurate and layered division of the PUJ was easily performed. The average procedure time was 37.5 min. Our overall success rate was 87.5%. CONCLUSION: The holmium:YAG laser is a safe, reliable laser with adequate coagulative properties and precise cutting abilities. This allows a 'bloodless' operative field for controlled, accurate and safe endoscopic division of the PUJ.

Adult↗
PubMed1996

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Exobiology↗
PubMed1996

Circumcision: how do urologists do it?

OBJECTIVE: To determine the range of surgical techniques, analgesic practice, post-operative care and follow-up procedures used in the circumcision of children by urologists in the United Kingdom, and to suggest changes which would improve patient care and medical training in the relatively simple procedure of circumcision. MATERIALS AND METHODS: In 1994, all consultant urologists in the United Kingdom were sent detailed questionnaires asking about their practices in the circumcision of children. RESULTS: Of 308 urologists, 61% replied; of these, 55% use the sleeve-resection technique and 39% the free-hand method, and 57% use diathermy, half of which is bipolar. There is wide variation in the type of post-operative analgesia; 95% use an initial dressing but few recommend any subsequent dressing, 70% perform all circumcisions as day cases and 48% review patients in the clinic. There is significant concern that circumcision is not taught adequately to junior surgeons. CONCLUSION: The sleeve technique of resection should be more widely used. Analgesic practice could be improved with greater use of regional anaesthetics. Most urologists promote no specific care after discharge. There is probably a place for increasing the use of alternative procedures to circumcision.

Analgesia↗