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Biomedical subjects

J Cumming

Publications and source records attributed to J Cumming.

17 recordsLinked to original sources
PubMed1991

Treatment of organic impotence.

A review of 86 patients referred to a urological clinic with impotence showed that in 58% the causation was predominantly psychogenic. These patients were managed with psychosexual counselling. The various treatment options were discussed with those patients with organic impotence and 14 underwent the implantation of a penile prosthesis. A review of 130 patients who received penile prostheses in the period 1983 to 1987 was carried out to compare the complications and results obtained with the various types of prosthesis. The overall satisfaction rate was 81%; dissatisfaction usually arose as a result of complications of surgery. These were highest in patients with diabetes and priapism. The complications were also related to the type of prosthesis used.

Bacterial Infections↗
PubMed1990

Distribution of bony metastases in prostatic carcinoma.

Fifty-five prostate cancer and 55 breast cancer patients with positive bone scintigrams were studied. The pattern of spread in the axial skeleton and pelvis showed differences between the 2 groups. This difference was not related primarily to bone volume at the site of metastasis. The difference in distribution of bony metastases between breast and prostate is explained by our knowledge of Batson's vertebral venous plexus.

Bone Neoplasms↗
PubMed1989

Role of the Kock pouch in adolescent urology.

Although cutaneous urinary diversion will continue to have a place in some urological diseases, some patients may benefit from an undiversion. The Kock pouch with a continent reservoir is an alternative where conventional undiversion to the bladder is impossible. Indications, pre-operative preparation, operative technique, results and complications are outlined in detail. In the adolescent patient requiring urinary diversion the Kock pouch should be considered as the last resort. Where reconstruction of the urinary tract is impossible, a continent urinary reservoir by means of the Kock pouch may be indicated.

Adolescent↗
PubMed1989

The Mitrofanoff principle for continent urinary diversion.

A continent urinary diversion was formed for 16 patients using the Mitrofanoff principle for continence. As originally described, this system used the appendix tunnelled into the bladder to form a continent catheterisable vesicostomy. We have expanded the technique and have used all available narrow tubes as continent conduits (ureter 10 cases, appendix 5, Fallopian tube 1). The urine container was made of large and small intestine and bladder in several combinations. The system has been very satisfactory: 14 patients were continent and able to catheterise; 1 required a revision to achieve continence and 1 awaits revision; 3 patients required revision procedures for stricture.

Adolescent↗
PubMed1988

Acute myometritis and chorioamnionitis during cesarean section of asymptomatic women.

Postoperative endomyometritis develops in as many as 85% of women undergoing cesarean section, which is 10- to 30-fold higher than after vaginal delivery. The timing and mechanism by which the infecting organisms gain access to the uterine cavity are unclear. One possibility is that the infection may occur postpartum by ascending colonization of the wound. Alternatively, myometritis may be already present at the time the cesarean section is performed in asymptomatic patients. With tissue necrosis, the stage is then set for puerperal endomyometritis. To study this second alternative mechanism, myometrial and placental biopsy specimens were obtained in 91 asymptomatic patients at the time of cesarean section. Histologic evidence of chorioamnionitis was identified in 10% (9/91) of patients. Acute myometritis was present in 11% (10/91) of the myometrial biopsy specimens. Seven of the nine women (77%) with subclinical acute chorioamnionitis demonstrated extension of the inflammation into the myometrium. Thirty-two percent (8/25) of women in labor and 31% (5/16) of those with rupture of membranes for greater than 6 hours had acute chorioamnionitis or myometritis, which is significantly higher (p less than 0.01) than in women without these risk factors. These findings suggest that approximately one third of asymptomatic women with rupture of the membranes for more than 6 hours or who are in labor at the time of cesarean section demonstrate histologic evidence of subclinical chorioamnionitis. In most of these patients the myometrium is also involved. The uterine incision is then performed through infected myometrium, possibly setting the stage for puerperal endomyometritis.

Acute Disease↗
PubMed1988

Urinary undiversion in young adults.

Eighteen patients who underwent urinary diversion in childhood were undiverted. There were three main groups: the neurologically intact bladder, the neuropathic bladder and the "occult" neuropathic bladder. The simplest procedure of anastomosing the proximal ureters to the distal ureters was preferred. The neuropathic group required excision of the bladder remnant and substitution with detubularised bowel. In four patients the renal function was progressively deteriorating pre-operatively and two have required transplants. Renal failure in one of these patients was accelerated by a post-operative anastomotic stenosis and infection, although his early post-operative anastomotic stenosis and infection, although his early post-operative course was uneventful.

Adolescent↗
PubMed1986

Long-term management of patients who have had urinary diversions into colon.

Thirty-four patients with urinary-colonic diversions have been followed up for 13 to 41 years (mean 20.3). The commonest long-term complication was hyperchloraemic acidosis (50%). The most serious was neoplasm at the anastomotic site: benign lesions occurred in three patients and carcinomas in two (15%). Staining for sialomucins in colonic biopsies adjacent to the anastomoses was positive in 17 of 19 patients. It has been suggested that this represents a pre-malignant change. Analysis of faecal flora in 17 diverted patients and 27 controls revealed a significant difference in the carriage rate and viable count of Peptostreptococcus species. This finding has not been reported previously and the species could have a role in the aetiology of the neoplasms.

Colon↗
PubMed1976

Discharges against medical advice from voluntary psychiatric units.

About one in every six voluntary mental patients discharges himself against medical advice. But despite the high rate of AMA discharges, the authors found the literature on the subject to be sparse and of little help in explaining why patients leave the hospital against medical advice. They examine the approaches that have been used thus far to study the phenomenon. They also report the findings of their own study, which showed that patients discharged against medical advice had a poorer response to treatment than those discharged in the traditional manner. The study identified factors that contributed to the poor response and were related to the discharge.

Acute Disease↗
PubMed1975

The impact of mass transfer on patient release.

In 1971, budget restrictions in New York State provided the impetus for the transfer of 2,174 patients among state hospitals in the mental hygiene system. The discharge rate was greatly increased over what would have been expected, but varied greatly among the receiving hospitals. The major factor relating to this difference appears to be the values and beliefs of the receiving hospitals as to the proper placement of patients. The patient's return to the hospital after discharge did not relate to a liberal discharge policy, but seemed to depend on whether or not the patient was physically healthy and could meet minimal social role expectations. Factor usually associated with probability of discharge are analyzed, but while some, such as age, affect chances of discharge, none are as potent predictors as the type of hospital.

Acute Disease↗