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Biomedical subjects

D Cranston

Publications and source records attributed to D Cranston.

At least 55 records · Page 3Linked to original sources
PubMed1995

Efficiency in the outpatient department: the lessons from urology.

To determine the scope for improvements in efficiency in the outpatient management of urological patients, a retrospective analysis was undertaken of outpatient records from one consultant's practice in a regional teaching hospital. Two hundred consecutive patients referred between March and May 1992 were studied for 1 year after referral. Each outpatient visit was judged to be unavoidable or potentially avoidable. Of referrals, 72% were in one of four diagnostic categories (bladder outflow obstruction; haematuria; scrotal disorders; frequency/dysuria syndromes). Of these patients, 90% were seen only once or twice for each episode of illness. Of the visits, 150/347 (42%) were potentially avoidable. Patients with suspected bladder outflow obstruction, haematuria and scrotal disorders should undergo imaging of the relevant anatomy before referral. Patients with haematuria should be referred directly for a flexible cystoscopy after imaging. Urologists need to educate general practitioners more clearly about the indications for the treatment of scrotal swellings in elderly men and mild bladder outflow obstruction in middle-aged men. Patients need not be reviewed routinely after transurethral resection of the prostate for benign prostatic hypertrophy or after investigations for haematuria have revealed no serious abnormality.

Efficiency, Organizational↗
PubMed1994

Fatherhood without apparent spermatozoa after vasectomy.

Fatherhood after vasectomy is rare. We describe 6 cases of DNA-proven fatherhood after vasectomy in association with persistently negative semen examination. All vasectomy patients and their partners should be counselled about the small possibility of late failure, and warning of failure should be recorded.

Female↗
PubMed1993

The mobile lithotriptor: an answer for the smaller centre.

The mobile lithotriptor is a new method of providing extracorporeal shock wave lithotripsy (ESWL) directly to the smaller urological centres. The unit, containing a Dornier HM4 lithotriptor, has treated 135 patients with a total of 168 treatments in 2 centres in the Oxford region. The overall success rate was 87% with no serious morbidity or mortality. The results compare well with the results from larger centres and the system is cost-effective. We suggest that it is one of the best methods of providing ESWL to the smaller urological centres.

Adolescent↗
PubMed1993

Effect of prior bilateral nephrectomy on haemoglobin and blood pressure outcome after transplantation.

Changes in blood pressure and haemoglobin concentration before and after renal transplantation were compared in 15 patients with renal failure due to chronic pyelonephritis who had undergone pretransplant bilateral nephrectomy and 15 control patients whose primary renal disease was chronic pyelonephritis and who were matched for age, sex and graft function but had not undergone nephrectomy. Bilateral nephrectomy resulted in a significant worsening of anaemia prior to transplantation and a decline in blood pressure. However, by 6 and 12 months after renal transplantation both haemoglobin and blood pressure were similar in nephrectomized and non-nephrectomized patients and in the normal range. We conclude that in patients with renal failure due to chronic pyelonephritis, pretransplant nephrectomy has no major impact on long-term blood pressure and haemoglobin levels achieved after successful renal transplantation.

Adult↗
PubMed1991

Bilateral nephrectomy before transplantation: indications, surgical approach, morbidity and mortality.

Forty patients with end-stage renal failure, who had undergone simultaneous bilateral native nephrectomy before a subsequent renal transplant operation, were reviewed with particular reference to the indications and surgical approach for bilateral nephrectomy and to the complications of the procedure. The main indications for bilateral nephrectomy are hypertension resistant to medical therapy, persistent symptomatic renal infection, severe renal protein loss and occasionally polycystic kidneys or bilateral renal tumours. In this consecutive series of 40 patients both kidneys were removed because of chronic pyelonephritis with reflux (n = 28), glomerulonephritis with reflux (n = 9) and uncontrolled hypertension (n = 3). Surgical morbidity was less in patients who had bilateral nephrectomy performed through bilateral vertical lumbotomy incisions. There was no surgical mortality.

Bacterial Infections↗
PubMed1991

The combined effect of perioperative donor spleen cells or KCl-extracted antigen and cyclosporine on renal allograft survival in the rat.

The effects of using perioperative cyclosporine in conjunction with pretreatment with donor spleen cells or 3M KCl solubilized extracts of donor antigen were investigated in a LEW-to-DA rat renal allograft model. Cyclosporine given orally in a dose of 10 mg/kg/day around the time of transplantation (days -1, 0, +1), did not prolong renal allograft survival (median survival time [MST]--10 days). However when used in combination with pretreatment with either 10(8) donor spleen cells (1 day before transplantation), or 10(5) donor spleen cells (7 days before transplantation), pretreatment regimens that were in themselves ineffective, DA recipients accepted Lewis renal allografts indefinitely (MST greater than 100 days). Soluble antigen was prepared by 3M KCl extraction from donor spleen cells. Absorption assays were used to quantify the amount of class I major histocompatibility complex antigen in the preparation, and amounts of antigen equivalent to that expressed by 10(6)-10(8) donor spleen cells were used for pretreatment. These soluble antigen preparations given either 1 or 7 days before transplantation with or without perioperative cyclosporine did not prolong allograft survival of either homozygous or heterozygous donors (MST 10 days).

Animals↗
PubMed1991

Urinary retention after pyeloplasty.

A retrospective review of 37 pyeloplasties, performed between 1984 and 1988, revealed that 38% of patients had post-operative retention requiring catheterisation, compared with 8% in an age and sex matched group of patients undergoing cholecystectomy. This suggests that direct surgical trauma to the upper genitourinary system may inhibit bladder function. We therefore suggest that pre-operative catheterisation should be considered in theatre, for patients undergoing pyeloplasty.

Adolescent↗
PubMed1991

Flexible cystoscopy compared with ultrasound in the detection of recurrent bladder tumours.

A combination of transrectal and transabdominal ultrasound was compared with flexible cystoscopy as a means of detecting recurrent bladder tumours. The study group comprised 50 patients who had previously had rigid cystoscopy. They underwent combination ultrasound in the out-patient department 1 week before flexible cystoscopy. Combination ultrasound identified 25 patients with recurrent tumours and flexible cystoscopy identified 26. Thirty-four patients (68%) preferred ultrasound, 10 (20%) preferred flexible cystoscopy, 3 (6%) preferred general anaesthesia and rigid cystoscopy and 3 (6%) had no preference. The main objection to ultrasound was the use of the transrectal probe.

Aged↗
PubMed1991

Effect of blood transfusion on survival after radiotherapy as treatment for carcinoma of the prostate.

Over a 14-year period, 71 patients underwent transurethral resection of the prostate with high dose radiotherapy. Eighteen patients required perioperative transfusion. The 5-year survival in the non-transfused group was 66% and in the transfused group 17% (P less than 0.001; chi 2 = 11.57). Recurrence of tumour in the transfused group was 72% compared with 21% in the non-transfused group (P less than 0.01; chi 2 = 9.1). When Cox's models and regression analysis were used, the disease state being controlled for grade and stage, only blood transfusion was seen to influence outcome. We conclude that careful thought should be given before transfusing patients undergoing transurethral surgery for prostatic carcinoma.

Aged↗
PubMed1990

The long-term outcome following "special clearance" after vasectomy.

Between 1980 and 1985, 6067 out-patient vasectomies were performed under local anaesthesia at the Elliot Smith Clinic in Oxford. During this period 151 men (2.5%) were given a "special clearance". This sanctioned the discontinuation of other forms of contraception despite the persistence of scanty (less than 10,000/ml) sperm in 2 consecutively examined semen samples at least 7 months after vasectomy. These men have been reviewed and further specimens of semen requested after a minimum follow-up of 3 years (range 3-8); 50 patients supplied a specimen and all except 1 were azoospermic. No pregnancies attributable to failure of the vasectomy have been identified.

Adult↗
PubMed1990

Cobb's collar--a forgotten entity.

Cobb's collar or Moormann's ring is a stricture of the bulbar urethra which is largely unrecognised but has considerable relevance urologically as the site of congenital or post-instrumental strictures. The history, anatomy, embryology and surgical importance are reported.

Adult↗
PubMed1990

The role of abdominal and transrectal ultrasound and cytology in the detection of recurrent bladder tumours.

Transrectal and transabdominal ultrasound combined with cytology were compared with conventional cystoscopy as a mean of detecting recurrences of bladder tumours. One hundred and twenty-five patients underwent combination ultrasound in the outpatient department 1 week before cystoscopy. Combination ultrasound identified 90% of recurrent tumours and tumour identification with the results of ultrasound and cytology combined was 93%. The false positive rate was 2%. The ultrasonographer would have referred 97% of patients with recurrent tumour for cystoscopy. Combination ultrasound and cytology may be a satisfactory alternative to check cystoscopy in certain categories of bladder tumours.

Adult↗
PubMed1989

The effect of hyperglycaemia on pancreatic islets transplanted into rats beneath the kidney capsule.

The effect of hyperglycaemia on islet transplantation in the rat has been examined in two ways, using syngeneic transplantation of 400 islets to the kidney capsule and subsequent measurement of kidney insulin content as a measurement of B-cell survival. Firstly, islets were transplanted into either diabetic or normal rats, then 6 months later the composite kidney/islet graft was transplanted into a normal rat. The insulin content was measured after a further 6 months and was found to be significantly reduced in islets exposed to hyperglycaemia in the primary recipient. These findings are interpreted as showing that long-term exposure of islets to hyperglycaemia results in B-cell loss. In the second experiment 400 islets were transplanted into either a long-term (6 months) diabetic or a normal rat. Two weeks later the composite kidney/islet graft was transplanted into a normal rat. The insulin content was measured after a further 6 months and no significant difference was found, whether the primary recipient was diabetic or not. These results are interpreted as showing that islet graft implantation is not impaired in long-term diabetic rats.

Animals↗
PubMed1989

Detection of recurrent bladder tumours by transrectal and abdominal ultrasound compared with cystoscopy.

Transrectal and transabdominal ultrasound was used to detect the recurrence of bladder tumours and compared with conventional cystoscopy. Forty patients with a previous history of bladder tumour were examined by these methods; 50% had a recurrence. Transabdominal and transrectal ultrasound together identified 95% of recurrences; 1 tumour (diameter 1 mm) was missed. The false positive rate was 5% and these areas, identified wrongly by ultrasound as tumour, were shown to be scars on cystoscopy. Combination ultrasound may be used as an alternative to check cystoscopy in certain categories of bladder tumour.

Abdomen↗