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Biomedical subjects

D S Elliott

Publications and source records attributed to D S Elliott.

At least 19 recordsLinked to original sources
PubMed2005

Is a fat stitch required when closing a hip hemiarthroplasty wound without a drain?

Studies have shown no benefit of a subcutaneous fat stitch when closing hip wounds, but all have been in the presence of a drain. Our aim was to determine whether, in the absence of a drain, suturing or not of the subcutaneous fat layer in hip hemiarthroplasty wounds had any significant effect on wound complication rate. We performed a prospective cohort study of 45 hip hemiarthroplasty patients who had a fat stitch and 40 who did not. No drains were used in either group. There were 44 patients in the fat stitch group and 35 in the no fat stitch group after six patients were excluded. The infection rate was 2% for the fat stitch group, and 20% for the no fat stitch group (p=0.02). There were no cases of deep dehiscence in the fat stitch group, but four cases (11%) in the no fat stitch group (p=0.035). The overall complication rate in the fat stitch group was 6.8% compared to 33% in the no fat stitch group (p=0.007). In the absence of a drain, we have found a significant increase in hip hemiarthroplasty wound complications when the subcutaneous fat is not sutured.

Aged, 80 and over↗
PubMed2005

Fragility fractures of the ankle: stabilisation with an expandable calcaneotalotibial nail.

Fragility fractures of the ankle occur mainly in elderly osteoporotic women. They are inherently unstable and difficult to manage. There is a high incidence of complications with both non-operative and operative treatment. We treated 12 such fractures by closed reduction and stabilisation using a retrograde calcaneotalotibial expandable nail. The mean age of patients was 84 years (75 to 95). All were women and were able to walk fully weight-bearing after surgery. There were no wound complications. One patient died from a myocardial infarction 24 days after surgery. The 11 other patients were followed up for a mean of 67 weeks (39 to 104). All the fractures maintained satisfactory alignment and healed without delay. Six patients refused removal of the nail after union of the fracture. The functional rating using the scale of Olerud and Molander gave a mean score at follow-up of 61, compared with a pre-injury value of 70.

Aged↗
PubMed2001

Determination of the phase difference between even and odd continuum wave functions in atoms through quantum interference measurements.

We establish a technique for the determination of the phase difference between even and odd parity continuum wave functions in atoms. This determination is based upon our detailed measurements of a quantum mechanical interference between two photoionization processes using a two-color laser field. We present our measurement of the phase difference between the continuum p and d waves in atomic rubidium, which is in good agreement with the expected value.

Journal Article↗
PubMed2001

Percutaneous plating of the low energy unstable tibial plateau fractures: a new technique.

We discuss the management of two low-energy unstable tibial plateau fractures in this report, and describe our new technique of percutaneous plating to stabilise these fractures. This minimally invasive surgery has the obvious advantages to the traditional open reduction and internal fixation and the non-operative management by plaster immobilisation. Stable fixation can be achieved by small fragment plates used in this technique allowing safe mobilisation. This novel method of internal fixation could be a useful inclusion in the armamentarium for the management of tibial plateau fractures and can be safely practised by an orthopaedic surgeon at a District General Hospital.

Adult↗
PubMed2001

The "bends" and neurogenic bladder dysfunction.

Decompression sickness (the "bends") is a well-known risk of scuba diving. The pathophysiology and treatment is well documented. In the urologic data, no reference to the development of a neurogenic bladder as a result of an episode of the bends was found. We present the evaluation and management of a previously asymptomatic man who developed detrusor hyperreflexia after an episode of decompression sickness. Urologists in coastal communities should be aware of the potential risk of the development of neurogenic bladder.

Decompression Sickness↗
PubMed2001

Does nocturnal deactivation of the artificial urinary sphincter lessen the risk of urethral atrophy?

OBJECTIVES: To compare nocturnal deactivation with nocturnal activation of the artificial urinary sphincter (AUS) to determine whether nocturnal deactivation reduces the risk of urethral atrophy and subsequent recurrent incontinence. To the best of our knowledge, no review comparing these two approaches has been performed. METHODS: At the Mayo Clinic, all patients are instructed to deactivate their AUS at night; at Baylor, all patients keep their AUS activated all the time. At each institution, a group of consecutive men with comparable severe urinary incontinence after radical retropubic prostatectomy were selected; 61 and 46 patients from the Mayo Clinic and Baylor, respectively, were available for review. All Mayo Clinic patients strictly adhered to nocturnal deactivation of their AUS and all 46 patients from Baylor kept their AUS activated at all times, except during voiding. Each patient was reviewed for the long-term risk of subsequent reoperation, especially regarding recurrent incontinence due to urethral atrophy. RESULTS: Seventeen (27.8%) of the 61 patients from Mayo (mean follow-up 40 months) required a repeated operation. Of the 17 AUS failures, 6 (35%) were due to urethral atrophy. Of the 46 patients from Baylor (mean follow-up 28 months), 16 (34.7%) required a repeated operation. Of the 16 AUS failures, 10 (62%) were due to urethral atrophy. Overall, the patients who nocturnally deactivated their AUS had a 10% risk of atrophy-related incontinence compared with a 21% risk in the nocturnally activated group. CONCLUSIONS: Although not statistically significant, nocturnal deactivation appears to decrease the risk of urethral atrophy and recurrent incontinence (10% versus 21%). Nocturnal deactivation should be considered in men who are dry at night and have sufficient motivation to lessen the risk of urethral atrophy secondary to cuff compression.

Atrophy↗
PubMed2001

Is nephroureterectomy necessary in all cases of upper tract transitional cell carcinoma? Long-term results of conservative endourologic management of upper tract transitional cell carcinoma in individuals with a normal contralateral kidney.

OBJECTIVES: To evaluate the endoscopic management of upper urinary tract transitional cell carcinoma (TCC) as a first-line treatment in patients with a normal contralateral kidney. METHODS: During an 11-year period, 21 patients diagnosed with upper tract TCC were treated with conservative endourologic techniques using either neodymium:yttrium-aluminum-garnet laser or electrocautery at our institution. The 21 patients were followed up for a mean of 6.1 years (range 1 to 11.6). RESULTS: A total of 8 renal pelvic tumors and 13 ureteral tumors were found. All tumors were Stage T1 or less and grade 3 or less. All tumors were less than 2 cm in the greatest dimension (range 0.4 to 2). Of the 21 patients, 7 (33%) had one local recurrence and 1 (4.7%) developed two local recurrences. Of the 13 ureteral tumors, 6 (46%) recurred; 1 (12%) of the 8 renal pelvic tumors recurred. No recurrent tumor was shown to have an increase in grade. Of the 21 target renal units, 17 (81%) were preserved; 4 (19%) of 21 patients required nephroureterectomy because of tumor recurrence. Overall, 11 patients in the series died, 10 of non-TCC etiology and 1 secondary to invasive bladder TCC that developed after treatment for upper tract TCC. No patients died as a result of conservative management of their upper tract TCC. CONCLUSIONS: Endourologic techniques and conservative treatment of upper tract TCC is an evolving field; however, in properly selected patients, endoscopic treatment can be safely and effectively used as a first-line treatment for upper tract TCC.

Adult↗
PubMed2001

Combined stent and artificial urinary sphincter for management of severe recurrent bladder neck contracture and stress incontinence after prostatectomy: a long-term evaluation.

PURPOSE: Concurrent incontinence and severe recurrent bladder neck contracture following radical prostatectomy are difficult to manage. Recurrent anastomotic strictures following repeat transurethral incisions and resections, and the need for frequent instrumentation are contraindications for artificial urinary sphincter placement. Usually treatment alternatives for these patients consist of some form of urinary diversion or chronic catheter drainage. We evaluated our results using a UroLume stent across the bladder neck contracture followed by placement of an artificial urinary sphincter. MATERIALS AND METHODS: After failed multiple (mean incisions 4.4) attempts at conservative management of anastomotic stricture 9 men were treated with a UroLume urethral stent across the contracture followed by artificial urinary sphincter placement after appropriate epithelialization of the stent was confirmed. RESULTS: All patients were followed for a mean of 17.5 months. Mean pad use per day decreased from 6.5 to 0.7 before and after artificial urinary sphincter placement, respectively. Two patients reported mild persistent perineal discomfort and 1 had a recurrent contracture after stent placement, which was successfully managed with placement of a second overlapping stent. Overall, 89% of the patients were satisfied with the results. CONCLUSIONS: UroLume stent placement followed by artificial urinary sphincter can be a successful method for treating recurrent severe bladder neck contracture and incontinence. There is minimal morbidity with the procedures, and the combination offers a much more attractive treatment alternative compared to urinary diversion or chronic catheter drainage.

Aged↗
PubMed2000

Recent advances in the management of the neurogenic bladder.

Proper evaluation of the neurogenic bladder remains the cornerstone for accurate management of the neurologically impaired patient. Due to the inherent progressive nature of many neurologic disorders causing bladder dysfunction and lack of targeted medical therapy, much work has been done and needs to be done to advance the management of this often-difficult patient population. This article reviews the latest advances in managing the neurogenic bladder. For ease of review, the neurogenic bladder can be divided into 2 basic categories: first, bladders that fail to empty successfully and, second, those that fail to store urine adequately. Therapy should be based on these categories because poor therapeutic results are seen when a standard treatment is prescribed for the wrong bladder condition. Given the success of other specialties (physical medicine and rehabilitation, orthopedics, and neurology) at improving and prolonging the lives of the neurologically impaired patient, the urologist has an increasing responsibility to evaluate and treat the neurogenic bladder effectively over a life span that is approaching that of the normal population.

Anastomosis, Surgical↗
PubMed2000

Is fascia lata allograft material trustworthy for pubovaginal sling repair?

OBJECTIVES: In a recent publication, cadaveric fascia lata used for pubovaginal sling procedures was reported as having an early, rapid, and high failure rate. Recurrent incontinence was reported to occur from 1 week to 5 months after surgery. The study concluded that cadaveric tissue should not be used for urogynecologic procedures. Their results, however, were significantly different from what we found in clinical practice. We reviewed our series of cadaveric pubovaginal slings to determine the occurrence of rapid breakdown of cadaveric sling tissue leading to recurrent stress urinary incontinence. METHODS: At our institution, since June 1998, pubovaginal slings have been performed using only cadaveric fascia lata. Because all of the failures in the aforementioned study occurred within 5 months (mean 11 weeks) of surgery, we included in our series only patients with a minimum of 12 months of follow-up to ensure a long enough follow-up period for failure of the donor tissue to occur. Duration of follow-up and current continence status was documented. RESULTS: Twenty-six patients, with a mean follow-up of 15 months (range 12 to 20), were evaluated. Twenty-four of 26 (92%) patients used one or fewer pads per day: 20 of 26 (77%) were completely dry and 4 of 26 (15.4%) used only one pad per day. Two of 26 (7.7%) required two pads per day. Twenty-five of 26 (96%) reported being "significantly improved" and were "very pleased and satisfied" with the results of surgery. CONCLUSIONS: We found no evidence of rapid degradation of solvent-dehydrated cadaveric tissue resulting in early recurrent incontinence. We think these data support the continued use of cadaveric allograft material, especially given its intraoperative and postoperative advantages. Clearly, long-term evaluation of the durability of the cadaveric slings in comparison with autologous fascia is warranted.

Adult↗
PubMed2000

Perceptual organization in schizophrenia: the processing of symmetrical configurations.

The hypothesis that the perceptual organization dysfunction of patients with poor premorbid schizophrenia is due to a deficit in global visual sensory store processing was tested by assessing their ability to process symmetrical configurations that develop early and have strong prepotent structures. Two same-different judgment tasks in which performance varies as a function of the symmetrical organization and task demands were administered to participants with good and poor premorbid schizophrenia, those with mood disorders, and normal controls. Like the other groups, poor premorbid schizophrenics' latency and error response patterns closely paralled the a priori model of adequate processing. The results support their competence in perceptually processing symmetrical configurations and disconfirm the hypothesis that their input deficiencies represent a general deficiency in all forms of perceptual organization. The implications for specifying their early input dysfunction are discussed.

Adolescent↗
PubMed2000

Urethral devices for managing stress urinary incontinence.

Although surgery remains the gold standard for managing the majority of patients with stress urinary incontinence or retention, not all patients are suitable candidates or desire surgery. For these patients, several urethral caps and inserts are available, which are described. In approximately 50% of patients, satisfactory control is achieved. Further investigation undoubtedly will yield better devices to serve the large number of patients with urinary control problems.

Equipment Design↗
PubMed2000

Success of de novo reimplantation of the artificial genitourinary sphincter.

PURPOSE: We evaluate our experience with de novo reimplantation of the artificial genitourinary sphincter with a particular emphasis on mechanical and nonmechanical failure rates. De novo reimplantation is defined as implantation of an artificial sphincter following removal of a previously placed sphincter for erosion and/or infection and a waiting period of several months. MATERIALS AND METHODS: A retrospective analysis of more than 400 patients with an artificial sphincter revealed 23 who underwent de novo reimplantation between January 1983 and October 1998. All patients were men with a mean age of 66.5 years (range 16 to 88) and all had a urethral cuff. Reasons for cuff removal were erosion in 12 cases (52.2%), infection in 10 (43.5%) and intraoperative urethral injury in 1 (4.3%). Mean waiting period was 6.8 months (range 1.5 to 32) between explantation and de novo reimplantation. Mean followup was 32.6 months (range 1 to 108). RESULTS: Of the 23 patients 20 (87%) had no mechanical or nonmechanical failures and 3 (13%) had nonmechanical failures, including 2 patients (8.7%) whose cuff eroded into the urethra and 1 (4.3%) who had recurrent urinary incontinence which was successfully treated with implantation of a tandem cuff. There were no mechanical failures or infections in this group of patients. CONCLUSIONS: Our study suggests that de novo artificial sphincter reimplantation is an excellent treatment option. It is safe and associated with complication rates that are comparable to those of primary implantation.

Adolescent↗
PubMed2000

Artificial urinary sphincter implantation using a bulbous urethral cuff: perioperative care.

Urinary incontinence is a common problem encountered by clinicians and nursing staff. An artificial genitourinary sphincter (AGUS) placed around the bulbar urethra or bladder neck has become one of the gold standards for treating urinary incontinence due to sphincteric incompetence. It is imperative not only for physicians but also the nursing staff to have a working knowledge of the mechanics, risks, benefits, and durability of the AGUS to provide care for those patients encountered with an AGUS.

Humans↗