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Biomedical subjects

D J Ralph

Publications and source records attributed to D J Ralph.

45 records · Page 3Linked to original sources
PubMed1992

The management of the neuropathic bladder in adolescents with imperforate anus.

The management of 58 patients born with an imperforate anus who presented to the urology service and who are currently 18 years old or older is discussed. Of the 44 patients with a high imperforate anus 43 were treated by a rectal pull-through and 1 by an anal cut back procedure, while an anal cut back procedure was used in all 14 children with a low imperforate anus. A total of 32 children (55%) had a neuropathic bladder (hyperreflexic in 29 and atonic in 3). A spinal deformity was present in 72% of the hyperreflexic group but not in the atonic group. Vesicoureteral reflux occurred in 41% of the patients, two-thirds of whom had a neuropathic bladder. A total of 30 children had an associated genital anomaly and 27 had an upper tract anomaly. Nineteen children underwent an operation for the neuropathic bladder, with modern reconstructive methods involving substitution or augmentation cystoplasty, supplemented with self-catheterization, being superior to older methods with regard to continence. The incidence of a neuropathic bladder in these children is high in both operative groups but it is usually associated with a spinal deformity and unlikely to be iatrogenic in nature unless proved to be of lower motor neuron origin. Early operative management is advised to achieve continence and minimize renal impairment.

Abnormalities, Multiple↗
PubMed1992

Pre-operative assessment of Peyronie's disease using colour Doppler sonography.

Colour Doppler ultrasonography was used to assess 39 patients with Peyronie's disease with a suspected organic cause for their impotence. In 20 patients who complained of a uniform loss of erection, the impotence was likely to be functional in origin (90%) or occasionally venogenic (10%), the penile arterial blood flow being normal. However, patients who complained of distal flaccidity were likely to have an organic cause for their impotence (68%). This was due to proximal arterial disease (10%), plaque involvement of the distal vessels (37%), veno-occlusive dysfunction (5%) or to the soft glans syndrome (16%).

Adult↗
PubMed1992

The treatment of Peyronie's disease with tamoxifen.

This is a preliminary study of the treatment of 36 patients with Peyronie's disease who received tamoxifen 20 mg twice daily for 3 months. An improvement occurred in 16 of 20 patients with penile pain, in 11 of 31 patients with an erectile deformity and 12 of 35 patients had a plaque shrinkage of at least 1 cm. Some improvement occurred in 6 of the 8 patients with a histologically confirmed inflammatory infiltrate of the plaque but not in any of the 4 patients without an infiltrate. The inflammatory infiltrate was found in patients in whom the duration of the disease was less than 4 months.

Adult↗
PubMed1991

Surgery in HIV-positive and AIDS patients: indications and outcome.

We have reviewed the indications for and outcome of surgery in 147 patients who were seropositive for human immunodeficiency virus (HIV), 100 of whom have developed acquired immunodeficiency syndrome (AIDS). There were 256 operations; the commonest indications were anorectal conditions (34%), central venous access (21%), lymph node and soft tissue biopsy (15%) and an important minority underwent laparotomy (4%). Complications occurred in 20% of operations and repeat procedures were required in 35 patients. Both were of equal frequency in the HIV and AIDS populations. Most operations were therefore minor, and achieved satisfactory results with an acceptable morbidity. The possibility of HIV-related infection or malignancy affected the diagnostic and therapeutic approach, particularly in those considered for anorectal surgery or laparotomy. With increasing numbers of HIV-infected patients, knowledge of the types of surgery required and the likely outcome is important to enable provision of a safe and effective surgical service.

Adolescent↗
PubMed1990

Bladder calculus formation as a complication of the Stamey procedure.

Three cases of bladder stone due to a migrated Stamey suture and cuff are reported. In each case peroperative cystoscopy confirmed that the sutures were extravesical. The Stamey cuff subsequently formed a nidus for intravesical stone formation. The mechanism of migration of the cuff, the radiological findings and the operative technique are discussed.

Aged↗
PubMedDate not supplied

Novel PDE5 inhibitors for the treatment of male erectile dysfunction.

Erectile dysfunction (ED) affects the lives of approximately 150 million men worldwide. ED may be a cause of male sub-fertility in a significant proportion of patients. There is now an expanding armamentarium for the management of ED, including oral agents such as phosphodiesterase type 5 (PDE5) inhibitors. PDE5 inhibitors may also be useful in situations of temporary ED in couples undergoing IVF. Two novel PDE5 inhibitors have been commercially launched in the European Union in the first quarter of 2003. This article reviews the pharmacology and clinical efficacy of these new agents and their potential role in treating patients with male sub-fertility.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMedDate not supplied

Investigation of cavernosal smooth muscle dysfunction in low flow priapism using an in vitro model.

The effects of hypoxia (pO2: 50 mmHg), acidosis (pH: 6.9) or glucopenia (absence of glucose) in vitro on the tone of the rabbit corpus cavernosum were investigated. The recovery of smooth muscle contractility following exposure to these conditions was also assessed. Hypoxia, acidosis or glucopenia alone or in combination showed a sustained reduction in the tone. Reperfusion of tissue strips showed complete recovery of smooth muscle tone for all conditions except when hypoxia and glucopenia were combined or when hypoxia, glucopenia and acidosis were used in combination. Incomplete recovery of tone was associated with a significant reduction in tissue ATP concentrations and an increase in the number of TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling)-positive nuclei. This indicates that following reversal of hypoxia, acidosis and glucopenia, failure of conventional alpha-adrenergic agonists to produce tumescence in low flow priapism is associated with irreversible smooth muscle cell dysfunction, which is linked to ATP reduction and smooth muscle cell death.

Acidosis↗