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Biomedical subjects

J C Brocklehurst

Publications and source records attributed to J C Brocklehurst.

At least 19 recordsLinked to original sources
PubMed1992

Assessment of the use of bladder washouts/instillations in patients with long-term indwelling catheters.

A randomised cross-over study of 3 bladder washout treatments--saline, Suby G and Solution R--was conducted on 25 elderly females with long-term catheters in order to examine crystal formation and catheter encrustation. With 2 exceptions, all patients produced crystals; only 14 completed the study. While a significant reduction in struvite crystals was found in the returned acidic washout fluid, there was no significant reduction of crystals in the neutral (saline) washout following any of the 3-week periods of treatment. Uric acid crystals appeared with Suby G and Solution R and these solutions were associated with higher red cell deposits in the urine. There was no significant difference in catheter encrustation between the various washouts.

Aged↗
PubMed1990

Predicting urodynamic dysfunction from clinical features in incontinent elderly women.

In a retrospective survey of 296 elderly women referred with urinary incontinence and in whom urodynamic studies were completed, multiple logistic regression was used to determine the optimal set of clinical features to predict the urodynamic dysfunction. Three formulae were obtained expressing the predicted probabilities (p) of the urodynamic dysfunctions as functions of the clinical variables. By choosing the cut-off values of p which gave equal weighting to sensitivity and specificity, we found that clinical features (symptoms, signs, residual volume) are helpful in diagnosing the presence of unstable detrusor and voiding dysfunction, but not incompetent urethra.

Aged↗
PubMed1990

Rectal motility studies in faecally incontinent geriatric patients.

Rectal motility was assessed in three groups of geriatric patients (faecally incontinent, continent faecally impacted and control patients) to determine whether 'uninhibited' rectal contractions are a cause of faecal incontinence. The incidence of rectal contractions in response to rectal distension did not differ between the three study groups. Two-thirds of the incontinent patients were unable to retain a condom distended with water (soft-stool model) during a proctometrogram. Involuntary expulsion of this device was correlated with the presence of rectal contractions and low anal resting pressure. Involuntary expulsion of an airfilled balloon (firm-stool model) from the rectum occurred less frequently and was correlated with low resting pressure but not with rectal contractions. The contribution of 'uninhibited' rectal contractions to faecal incontinence is insignificant except for a minor role in the expulsion of liquid stool.

Aged↗
PubMed1990

Bacteriuria in non-catheterized elderly patients in the first eight days of hospital stay.

One hundred and sixty-one non-catheterized consecutive acute geriatric admissions were screened for bacteriuria on the day following admission, both in the morning and in the afternoon and seven days later--morning and afternoon. The prevalence of bacteriuria was 29% on admission. A correlation between bacteriuria and leucocyturia was shown. The patients were admitted with a variety of medical illnesses but in no case was a diagnosis of urinary-tract infection made prior to admission. There was a significant relationship between incontinence and bacteriuria on admission; 12% of abacteriuric patients became bacteriuric between day 1 and day 7 following admission. Escherichia coli accounted for 51% of the isolates on admission to hospital. Bacteriuria was associated with increased mortality within 1 year following admission to hospital.

Acute Disease↗
PubMed1990

Urinary incontinence in old age: helping the general practitioner to make a diagnosis.

Since urinary incontinence is one of the major presenting symptoms of illness in old age, all those who deal with this professionally should have a clear plan in mind as to how to proceed with diagnosis and management. Such a plan is outlined here based first of all on history and examination and easily performed tests and followed, if the problem still remains, by an empirical approach based on the major presenting symptom--urge incontinence, stress incontinence or incontinence of which the patient is unaware.

Aged↗
PubMed1989

Anal function in geriatric patients with faecal incontinence.

The association of faecal incontinence with constipation and confusion in the elderly is well recognised but the anal function of faecally incontinent geriatric patients is poorly understood. Anal studies were therefore performed on 99 geriatric patients (49 with faecal incontinence, 19 continent patients with faecal impaction and 31 geriatric control patients with normal bowel habit) and 57 younger healthy control patients. An age related reduction in anal squeeze pressure but not resting pressure was identified. A reduction in anal resting pressure was detected in the faecally incontinent geriatric patients but squeeze pressure did not differ significantly from that found in the other geriatric patients. Anal sensation was impaired in the faecally incontinent patients. No difference was found between the groups as measured by pudendal nerve terminal motor latency. Gross neuropathy of the distal part of the pudendal nerve does not account for the observed external anal sphincter weakness in geriatric patients or for their faecal incontinence. Internal anal sphincter dysfunction is an important factor in faecal incontinence in the elderly.

Aged↗
PubMed1988

A new urethral catheter.

A new balloon catheter for women with a flexible urethral portion that conforms to the shape of the closed urethra was tested. In sheep control catheters caused epithelial destruction, which was absent with the conformable catheter. A 12 week crossover trial compared control catheters in 52 long stay geriatric patients. Eighty two out of 91 conformable catheters were rated as comfortable compared with 68 of 87 control (p = 0.006). The average length of time in situ was 15.9 days for the conformable catheter compared with 12.9 days for the control (p = 0.001). The average number of bypasses a week with the conformable catheter was 1.1 compared with 1.3 for the control; this difference was not significant. Examination of 249 used catheters showed significantly fewer with intraluminal obstruction with struvite among the conformable than control catheters (1 (0.8%) versus 15 (11.5%); p less than 0.001). This new catheter for women is a substantial improvement over the Foley catheter and (except in urethral stricture) is suitable for all forms of drainage.

Aged↗
PubMed1988

Age changes in the human female urethra: a morphometric study.

Aging in the human female urethra can contribute towards urinary problems. To our knowledge the effect of age on urethral tissues has not been quantified previously. Histological sections were prepared from 8 regions along the length of the urethra from 26 women between 19 and 88 years old. Using quantitative morphological techniques the relative volume fractions of various tissue components were determined. As age increased there was a decrease in the relative volume of striated muscle and blood vessels, and an increase in the relative volume of connective tissue. There was no change in the smooth muscle components. These age changes in the human female urethra may lead to impairment of urethral function.

Adult↗
PubMed1988

Comparison of four urine drainage systems.

An evaluation of four urine drainage systems available for use by patients with indwelling urethral catheters and prescribed by general practitioners was performed. Twenty-four patients in the community of one health district tested each system for a number of weeks. Both users and carers responsible for the management of the urine drainage system tested their acceptability and reported on preference, methods of support, ease of use and comfort. The significance of the results and their implications for nursing are discussed.

Aged↗
PubMed1987

The epithelium in the female urethra: a quantitative study.

Histological sections were prepared from 8 regions along the length of the urethra in 16 women 19 to 82 years old. The epithelium was examined under the light microscope at 4 points in each region and the type of epithelium was classified. Our results indicate that the human female urethra is lined by stratified squamous, pseudostratified columnar and, occasionally, transitional epithelium. There is a gradual change from squamous to columnar epithelium with advancing age. More squamous epithelium is present at the distal end of the urethra.

Adult↗
PubMed1987

Study of patients with indwelling catheters.

Indwelling urethral catheters are used for the long-term management of intractable urinary incontinence or bladder outlet obstruction with resultant retention of urine. There are well-described problems associated with their use including urinary tract infections and mechanical problems. Urinary tract infections have been well researched, however mechanical problems associated with blockage of the catheter lumen due to encrustation, leakage of urine and general discomfort, have been the least investigated. To date, there has been no research of patients' views, understanding or feelings in relation to their catheters. This paper comprises a preliminary investigation of patients' understanding and knowledge of their catheter's location and function, its acceptance, problems associated with its use, social implications and its subsequent management. Thirty-six patients from the community of one health district were surveyed. It was concluded that an indwelling catheter is a prosthesis which, to be successful, requires adequate patient education and management. Education of the patient and carers is particularly important since an understanding of the catheter and its function will lead to better acceptance of the device and will enable better management of the urine drainage system.

Adaptation, Psychological↗
PubMed1986

Faecal incontinence in residential homes for the elderly: prevalence, aetiology and management.

Faecal incontinence occurring at least once weekly was found in 10.3% of residents in 30 residential homes for the elderly. Fifty-two randomly-selected incontinent residents were prescribed treatment and the outcome was compared with 30 incontinent residents acting as controls. The vast majority of all incontinent residents showed evidence of chronic brain failure (dementia). Incontinence had been present for over a year in 73%, yet only 4% had been referred to their general practitioner. Incontinence secondary to constipation or impaction and neurogenic incontinence were equally common. Full compliance with the recommended treatment was obtained in 66%, and 87% of these were cured. This compared with 32% of the control group during the same period (P less than 0.001). This study confirms that in the great majority of cases faecal incontinence in old people is both curable and preventable.

Aged↗
PubMed1986

The management of urinary incontinence in local authority residential homes for the elderly.

Urinary incontinence occurring at least once weekly was found in 32% of residents in 30 Local Authority Residential Homes for the Elderly. Incontinence was significantly commoner among female residents. One hundred and seventy-four incontinent residents were randomly selected in order to assess the effect of medical intervention (study group). A further 104 incontinent residents were selected to act as controls (control group). The vast majority of the study group showed evidence of chronic brain failure and 40% had impaired mobility. Almost half had been incontinent since admission. Urodynamic studies were required for management in only two (1.1%). Most (93%) were managed in accordance with a clinical diagnosis of an unstable bladder. There was a reduction in daytime incontinence in 40% of the study group, but this was matched by a reduction in 29% of the control group and the difference was not significant. The reduction in nocturnal incontinence in 41% of the treatment group was significantly different from 23% of the control group (P = 0.016).

Aged↗
PubMed1986

The ageing bladder.

The urinary bladder is a target for disorders in many systems--neurological, psychological, structural, infective and neoplastic. Most of these disorders become more prevalent as age advances and to them must be added the effects of biological ageing.

Age Factors↗
PubMed1985

Once-daily acebutolol and atenolol in essential hypertension: double-blind crossover comparison.

Acebutolol was compared to atenolol in 33 patients with mild to moderate essential hypertension (diastolic blood pressure greater than 95 mm Hg) with the use of a double-blind crossover study design. At 8 weeks of treatment, acebutolol, 400 mg once daily, and atenolol, 100 mg once daily, produced similar significant (p less than 0.01) reductions in average mean arterial blood pressure (12% and 11%, respectively) from baseline. Average heart rate at 4 weeks was also significantly reduced (p less than 0.01) from baseline (acebutolol, 14.8%; atenolol, 18.3%); the reduction with acebutolol, however, was significantly less (p less than 0.05) than that seen with atenolol. Both agents produced similar effects during exercise, and serum drug determinations showed acebutolol to be rapidly metabolized. Acebutolol appeared to be better tolerated: the frequency of side effects with acebutolol (24%) was less than with atenolol (45%). Acebutolol is as effective as atenolol in mild to moderate essential hypertension. Acebutolol appears to be better tolerated and to have a lesser effect on heart rate than atenolol.

Acebutolol↗