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Biomedical subjects

K H Murray

Publications and source records attributed to K H Murray.

9 recordsLinked to original sources
PubMed1990

Surgical management of the congenital neuropathic bladder.

We have previously described 3 types of lower urinary tract dysfunction in the congenital neuropathic bladder--contractile, intermediate and acontractile--accounting for 35, 40 and 25% of patients respectively. Subsequent urodynamic and surgical experience has shown that the intermediate type is commoner and the acontractile type less common than was thought. The contractile group accounts for 31% of patients and rarely requires surgery (a "clam" ileocystoplasty). The acontractile group accounts for only 9% but more commonly requires surgical treatment, usually the implantation of an artificial urinary sphincter (AUS). The intermediate group accounts for 60% of patients and usually requires surgery. If there is no significant sphincter weakness incontinence, a "clam" ileocystoplasty alone is performed; if there is sphincter weakness, a "clam and a cuff" procedure is performed with implantation of the remainder of the AUS at a later date, if required.

Humans↗
PubMed1988

Detrusor behaviour following implantation of the Brantley Scott artificial urinary sphincter for neuropathic incontinence.

During a 3-year period, 102 Brantley Scott artificial urinary sphincters were implanted to control urinary incontinence. Nineteen patients underwent endoscopic sphincterotomy and artificial sphincter implantation for the control of sphincter weakness incontinence due to congenital neuropathic bladder dysfunction. None had previous augmentation or substitution procedures. Nine patients (47%) subsequently showed a deterioration in detrusor function, resulting in either recurrent incontinence or upper tract dilatation. Eight of these (89%) had previously been shown to have an intermediate pattern of neuropathic bladder abnormality. All patients implanted with an AUS require long-term surveillance including videourodynamic studies, and patients with intermediate neuropathic bladders should be considered for augmentation or substitution at the time of implantation.

Adolescent↗
PubMed1987

Clam enterocystoplasty in the neuropathic bladder.

Clam enterocystoplasty has proved to be the most effective treatment for severe detrusor instability resistant to conservative treatment (Bramble, 1982; Mundy and Stephenson, 1985). More recently it has become the procedure of choice in patients with neuropathic bladders with hyper-reflexia or severely impaired compliance, provided that the bladder is of reasonable size and that gross fibrosis and/or diverticular formation of the bladder wall has not occurred. Fifty-nine patients have undergone the clam procedure as part or all of their reconstruction in the past 4 years. Although uncontrolled incontinence was the commonest indication, impaired renal function was the indication in 14 patients and need for undiversion in seven. Currently all but four are voiding satisfactorily or are on intermittent self-catheterisation, though six have significant stress incontinence. The clam procedure is easier, quicker and as satisfactory as substitution cystoplasty in selected cases.

Adolescent↗
PubMed1986

Complex urinary undiversion.

Thirty-one previously diverted patients with various complex lower urinary tract problems have been undiverted with simultaneous reconstruction of the anorectum and vagina when these structures were also affected. No patient was denied undiversion on the basis of pelvic pathology. The only contraindications were a lack of motivation and when the patient's general condition, intelligence and mobility made it an unrealistic proposition.

Adolescent↗
PubMed1986

Continence and potency preserving cystoprostatectomy and substitution cystoplasty for patients with bladder cancer.

Fifteen potent men with T3 M0 transitional cell carcinoma of the bladder underwent a technique for cystoprostatectomy designed to preserve the innervation of the distal sphincter mechanism and the corpora cavernosa, and substitution cystoplasty. All patients had previously had radiotherapy. When the neurovascular bundles were seen to be preserved all patients were continent by day (although one had objectively demonstrable stress incontinence) and 60% were potent. Damage to the neurovascular bundles was usually associated with impotence and a degree of stress incontinence, although the latter was correctable by implantation of an artificial sphincter. Cystectomy need not necessarily lead to an abdominal stoma or to impotence.

Aged↗
PubMed1977

Ocular involvement in leukaemia. Report of three cases.

Three patients with treated acute lymphoblastic leukaemia acquired visual symptoms believed to be caused by ocular infiltration by malignant cells. All three patients had other evidence of systemic disease including bone-marrow involvement at the time. One patient had a previous history of meningeal leukaemia and none had received "prophylactic" cranial irradiation. The ophthalmoscopic appearances were similar in each case and were thought to have been caused by obstruction of axoplasmic flow associated with infiltration of the optic nerve by neoplastic cells. The three patients were treated by local irradiation and two also received intrathecal chemotherapy. Response to treatment was variable but the use of radiotherapy combined with intrathecal cytoxic drugs is probably the best available approach.

Adult↗
PubMed1977

Erythroid hypoplasia in myelofibrosis: a feature associated with blastic transformation.

Four cases of myelofibrosis have shown a pattern which is usually found only where there is erythroid hypoplasia and in none of these was there evidence of extramedullary erythropoiesis. Three of these cases terminated in a blastic phase. The findings suggest that the occurrence of erythroid hypoplasia in myelofibrosis may be associated with blastic transformation--whether as a predisposing factor or as a secondary event is still speculative. This phenomenon is discussed in relation to the natural history of myelofibrosis.

Bone Marrow↗
PubMed1975

The management of anticoagulant therapy during and after pregnancy.

Fifteen patients were treated with oral anticoagulants during pregnancy. At 37 weeks they were changed to heparin and were given 5 mg of Vitamin K1 by intravenous injection. Labour was induced seven to ten days later. All infants were normal and healthy and in the 12 tested the cord prothrombin times were within the normal range.

Administration, Oral↗