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Biomedical subjects

D M Bolton

Publications and source records attributed to D M Bolton.

34 records · Page 2Linked to original sources
PubMed1994

Pediatric ureteropelvic junction obstruction treated with retrograde endopyelotomy.

OBJECTIVES: To determine the feasibility of retrograde endopyelotomy in the management of pediatric ureteropelvic junction (UPJ) obstruction. METHODS: We treated 2 boys aged 4 and 6 years with the Acucise endopyelotomy device for symptomatic ureteropelvic junction obstruction. The Acucise device was placed over a Lunderquist guide wire with fluoroscopic guidance only and routine Double J catheters were left in situ for 6 weeks after the procedure. The morbidity of the treatment and the short-term outcome were assessed. RESULTS: There were no acute complications and short-term follow-up results were satisfactory as determined by intravenous urography and diuretic renography. CONCLUSIONS: Ureteropelvic junction obstruction in children may be treated by retrograde endopyelotomy with the Acucise device. The principal potential advantage of this procedure is reduced morbidity. Our findings suggest that further evaluation is warranted.

Catheterization↗
PubMed1994

Hypothermia associated with percutaneous nephrolithotomy.

OBJECTIVES: To characterize the perioperative fall in core body temperature associated with percutaneous nephrolithotomy, and to identify patients at greater risk of hypothermia. METHODS: A retrospective review was undertaken of core body temperatures in 77 patients who underwent 95 percutaneous nephrolithotomy (PNL) procedures using room temperature irrigants over a 3 year period. Intraoperative temperature measurements were obtained via an esophageal thermistor probe. RESULTS: Mean core body temperature fell from 36.7 degrees C preoperatively to 35.8 degrees C after retrograde manipulations and subsequent patient positioning before commencing the renal puncture. The mean core temperature fell an additional mean 1.0 degrees C during the percutaneous nephrolithotomy. This additional temperature drop was proportional to the length of the procedure. Female patients had a significantly greater decline in intraoperative core body temperature than male patients (p < 0.01). Obese patients preserved their preoperative temperature more efficiently. Blood loss and advanced age had no impact on the occurrence of hypothermia. Mean preoperative temperature was regained on average within 3 hours postoperatively. CONCLUSIONS: Hypothermia occurs in the majority of patients undergoing PNL. Nearly an equivalent fall in temperature is seen during presurgical preparation, induction of anesthesia, and patient positioning as is seen during the surgical procedure itself. Efforts to preserve core body temperature both before and during the percutaneous procedure may reduce the degree of hypothermia and its potential complications.

Body Temperature↗
PubMed1994

Endoscopic ureteroneocystostomy for post-transplantation ureterovesical junction stenosis.

We report a new technique for the management of ureterovesical junction stenosis in a renal transplant recipient. Endoscopic retrograde resection of a bladder window permitted direct retroperitoneal vision and longitudinal incision of the distal ureter. Ureteral and bladder mucosa were in close proximity and were stabilized with a double-J catheter. This alternative transmural transvesical ureteroneocystostomy had minimal morbidity and may be an alternative to traditional open surgical repair of these lesions.

Adult↗
PubMed1994

Urologic applications at a community zoo.

The genitourinary system is a common source of disease in many animal species as well as humans, and the practice of comparative endourology is possible because of advances in the past decade in minimally invasive human surgery. Zoo veterinarians may have limited formal urologic training, and increasingly limited public funding resources now leave most community zoos without specialized endourologic equipment or expertise. Urologists may offer or be called on to assist in the diagnosis and management of often rare and valuable species, providing services and expertise previously limited to humans. Such cases may provide intellectual and technical challenges beyond those seen in clinical practice, while applying the same basic universal urologic principles. We describe a cooperative approach to the management of animal urologic disorders based on a 5-year experience as consultants to the San Francisco Zoo and encourage an interdisciplinary approach between urologists and their local zoos where this may be useful in the preservation and maintenance of these valuable and important public resources.

Animal Diseases↗
PubMed1994

Primary small cell carcinoma of the prostate: unusual modes of presentation.

Primary small cell carcinoma of the prostate is an uncommon condition. Between August 1989 and July 1991 seven patients with this pathology presented to the Repatriation General Hospital, Melbourne. Four of these patients presented by means not previously described. Included in this group is the first reported case of this tumour localized to the prostate gland and apparently cured by radical prostatectomy. The generally poor prognosis and lack of hormonal response associated with this condition warrant a greater awareness of the diagnosis among urologists.

Acid Phosphatase↗
PubMed1994

Risk factors predisposing to repeated extracorporeal shockwave lithotripsy.

The Victorian Lithotripsy Service is geographically unique, representing the only Australian lithotripter for a 900-km radius and serving a patient population of over 3 million, and 26 accredited operator urologists. Because of distance and health service constraints few patients treated for renal calculi on this machine have the opportunity to seek additional treatment by extracorporeal shockwave lithotripsy (ESWL) elsewhere. The treatment histories of all patients who underwent ESWL at this center over a 4-year period were examined, with those patients who required ESWL on more than one occasion being identified and their treatment details reviewed. The retreatment rate was approximately 6%. In patients who required three or more ESWL treatments multiple calculi were present significantly more often than in the overall cohort (p < 0.05), and ESWL alone was ultimately successful in obtaining satisfactory stone fragmentation in only 62% of this group. In view of the high cost of repeated treatments by ESWL the applicability of this treatment method in cases of multiple calculi should be questioned. Initial undertreatment of calculi may also represent a significant factor in the retreatment of some radiopaque calculi.

Adult↗
PubMed1993

CO 2 laser subcapsular orchidectomy in the treatment of prostate cancer.

Hormonal manipulation remains the main method of treatment in metastatic carcinoma of the prostate. Traditional techniques of surgical castration may result in complications due to bleeding within the scrotum. Because of its cutting and hemostatic properties the carbon dioxide laser has been used in performing subcapsular orchidectomy in an attempt to reduce such complications. Postoperative hormonal assays have demonstrated a response identical to orchidectomy, and no treatment complications were encountered in our series. Subcapsular orchidectomy using the carbon dioxide laser may offer an advantage over traditional methods of surgical castration by reducing the frequency of postoperative hematoma.

Evaluation Studies as Topic↗
PubMed1993

Renal cell carcinoma in both moieties of crossed fused ectopia.

Crossed fused renal ectopia is an uncommon condition and cases of malignant tumours in such anomalies are exceedingly rare. The first case where simultaneous involvement of both moieties and perirenal fat by tumour occurred is reported here. A comparison of the appearances of radiological investigations with the anatomical specimen is presented, as is a literature review of this topic.

Aged↗
PubMed1993

Randomised study of the effect of midnight versus 0600 removal of urinary catheters.

A randomised controlled trial was undertaken to determine the effects of midnight removal of urinary catheters on patients' voiding patterns and subsequent discharge from hospital. Patients whose urinary catheters were removed at midnight showed a greater volume of initial void than those whose catheters were removed at the usual time of 0600. Removal of urinary catheters routinely at midnight permits earlier assessment of patients' voiding, which may allow for earlier discharge from hospital.

Humans↗
PubMed1992

Nd:YAG laser ablation of the prostate as a treatment for benign prostatic hypertrophy.

Many techniques have been used to relieve obstructive symptoms associated with benign prostatic hypertrophy. Transurethral resection of the prostate (TURP) with an electrocautery loop is the most commonly performed operation to relieve bladder neck and urethral obstruction caused by prostatic adenoma. There is increased interest in alternative therapies to reduce prostatic size for symptom relief in this condition. We describe a technique using the neodymium:YAG (Nd:YAG) laser and a 600-microns laser quartz fibre with an attached terminal gold-plated metal alloy reflector to provide reliable deep penetration into prostatic tissue for prostatic adenoma ablation. We report the first use of this technique in three patients with benign prostatic obstruction and one with localised adenocarcinoma of the prostate.

Carcinoma↗
PubMed1992

Experience with the pulsed dye laser in management of ureteric calculi.

Pulsed dye laser lithotripsy is a recently developed technique for the management of urinary calculi. This article reports the results of treatment of a cohort of patients managed with this technology. Post-treatment bed stay was generally less than 48 h, narcotic analgesia was not regularly required, and no significant post-treatment complications were encountered. This treatment appeared to complement an existing extracorporeal shockwave lithotripsy (ESWL) service at St Vincent's Hospital and may offer a financial advantage in the treatment of patients with urinary calculi.

Adult↗
PubMed1992

Laser ablation of the prostate in patients with benign prostatic hypertrophy.

Seventeen patients with bladder neck obstruction due to benign prostatic hypertrophy have been treated with the Neodymium: YAG laser. We review our experience since the first patient was treated in September 1990. Using a prototype deflecting gold alloy tip on a quartz laser fibre (Lateralase TM), we ablated obstructing prostatic adenoma and constricting bladder neck tissue. Experience with this technique has enabled a patient population to be defined in whom laser therapy for prostatic obstruction may be effective. The treatment is relatively simple, speedy and attended by virtually no blood loss. Laser ablation therapy may offer some advantages over conventional transurethral resection of the prostate (TURP) in a selected subgroup of patients. The advent of new delivery systems may make laser ablation therapy a practical alternative to TURP.

Aged↗
PubMed1991

Comparative study of the role of endo-urological manipulation in the treatment of ureteric calculi using extracorporeal shock wave lithotripsy.

The results of treatment of 115 patients with upper and mid-ureteric calculi, using endo-urological manipulation and extracorporeal shock wave lithotripsy were reviewed. The number of shocks administered, the kilovoltage used, the radiation exposure time and the degree of fragmentation achieved were evaluated. Complications occurring in the course of this treatment were also reviewed. A significantly lower number of impulses was required for fragmentation to be apparent at 24 h post-treatment, when the ureteric calculus was able to be manipulated back into the renal pelvis. However, at 6 weeks post-extracorporeal shock wave lithotripsy (ESWL) satisfactory fragmentation was apparent in approximately equal percentages of patients who had undergone successful and unsuccessful manipulation. In addition, a significantly greater mean radiation exposure was used in the treatment of mid-ureteric calculi that could not be successfully manipulated and required treatment in situ within the ureter. These results suggest that treatment of a ureteric calculus in situ within the ureter provides a satisfactory method of fragmentation, although fragmentation takes longer to become apparent than when treatment is undertaken upon a calculus within the renal pelvis. The greater radiation exposure for patients in whom ureteric calculi were treated in in situ within the ureter may reflect the operators' attempts to visualize a change in configuration of the calculus similar to that seen when treatment is given to a stone that has been successfully manipulated. However, since the absence of fragmentation at 24 h post-surgery does not indicate a failed treatment in this group, prolonged screening of the calculus with fluoroscopy may be unnecessary. The complication rate of this method of treatment was low.

Adult↗
PubMed1988

Primary adenocarcinoma of the appendix in an inguinal hernia.

Primary adenocarcinoma of the appendix and primary carcinomata within hernial sacs are both uncommon clinical problems. A previously undescribed presentation of primary adenocarcinoma of the appendix in a right sided sliding inguinal hernia is presented and discussed. It is important to follow up patients with carcinoma of the appendix in order to exclude other colonic lesions. The St Vincent's Hospital (Melbourne) experience in this condition is limited but parallels that of major series elsewhere.

Adenocarcinoma, Mucinous↗