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Biomedical subjects

M C Bishop

Publications and source records attributed to M C Bishop.

At least 73 records · Page 4Linked to original sources
PubMed1986

Removal and replacement of Tenckhoff catheter at a single operation: successful treatment of resistant peritonitis in continuous ambulatory peritoneal dialysis.

8 episodes of persistent and 4 of recurrent bacterial peritonitis in 11 patients on continuous ambulatory peritoneal dialysis (CAPD) were treated successfully by the removal and immediate replacement of the Tenckhoff catheter. Intraperitoneal antibiotics, which had previously failed to produce clinical resolution of the peritonitis, were continued unchanged. Dialysate culture yielded Staphylococcus epidermidis (3 cases), Staphylococcus aureus (1 case), pseudomonas species (5 cases), acinetobacter (1 case), and no growth in 2 cases. Clinical and microbiological resolution was achieved in all 12 cases within 36 h. CAPD continued uninterrupted in 10 cases. 1 patient required temporary haemodialysis for 6 weeks because of dialysate leakage and later restarted CAPD. 1 patient chose haemodialysis as his long-term treatment when his new catheter failed mechanically on the second postoperative day. Replacement of the Tenckhoff catheter at a single operation without interrupting CAPD reduces the demand which temporary haemodialysis of these patients makes on centre dialysis facilities and may preserve the peritoneal cavity for dialysis by preventing the formation of adhesions.

Adult↗
PubMed1985

Bacteriology and ultrastructure of the bladder in patients with urinary tract infections.

Tissue obtained by biopsy of the bladder from 33 patients with various urinary tract symptoms was studied by conventional bacteriological techniques and by scanning electron microscopy (SEM). All the patients had recurrent urinary tract symptoms which had not completely responded to antibiotic therapy. Eleven of the patients had greater than or equal to 10(8) colony-forming units (CFU) of bacteria/1 urine; six had between 10(6) and 10(7) CFU/1, and 16 were abacteruric. Bacteria were isolated, however, from the tissue obtained by biopsy from eight of the 16 patients with sterile urine and bacteria were seen on the uro-epithelium in 14 of these patients. By comparison, in all samples of tissue obtained from the 11 patients with greater than or equal to 10(8) CFU/1 of urine bacteria were seen on the uro-epithelium and from nine of these, bacteria were subsequently grown. Fastidious organisms were not isolated from any of the patients. The uro-epithelium of all those studied was also shown to be grossly disrupted with increased disturbance and loss of the epithelial cells when compared with tissue obtained from uninfected patients. The degree of uro-epithelial disturbance was greatest in patients with histories of urinary tract infections lasting more than 4 months. The findings suggest that bacteriological examination of the urine does not always reflect bacterial infection on the bladder surface nor disruption of the uro-epithelium. The changes on the bladder surface may explain the patients' symptoms. In view of the results, a scheme is proposed that explains the development of symptoms in patients with urinary tract and bladder infections.

Adult↗
PubMed1985

Plasma hormone levels in patients with prostatic carcinoma treated with diethylstilboestrol and estramustine.

Plasma testosterone, oestradiol, luteinising hormone (LH) growth hormone and prolactin were measured serially in 140 patients with advanced prostatic carcinoma (T3, T4, MI and MO) randomised in a trial of diethylstilboestrol 3 mg/day against estramustine 560 mg/day. Both drugs suppressed plasma testosterone and LH and increased plasma growth hormone and prolactin, though estramustine induced a greater rise in prolactin. Oestradiol levels fell on stilboestrol but were considerably elevated on estramustine. Initial hormone levels reflected neither the extent of disease nor the response to treatment. The data also showed that close attention should be given to plasma LH in identifying patients who are unreliable, since intermittent hormone dosage caused an exaggerated rise even when plasma testosterone remained at castrate levels.

Aged↗
PubMed1985

Serial prostatic histology. A valid marker of response to hormone treatment.

Serial transrectal needle biopsies were taken from 146 patients (657 specimens) with advanced prostatic cancer (T3/T4, M1/MO) admitted to a trial of two forms of oestrogen therapy. Histological grading by Gleason and Mostofi techniques on the initial biopsy showed no correlation either with extent of disease or its eventual outcome on treatment. Change in grade was dissociated from the response of bone metastases to hormone treatment and did not appear to influence survival. However, the prognosis of 16 patients showing clearance of tumour from their serial biopsies was generally good.

Aged↗
PubMed1985

Bone imaging and serum phosphatases in prostatic carcinoma.

One hundred and twenty-seven patients with locally advanced prostatic cancer were evaluated for the presence and progress of bone metastases before and during hormonal therapy, by serial radionuclide imaging and frequent measurement of plasma acid (tartrate-labile) and alkaline phosphatase. For comparison, serial changes in imaging and phosphatases were classified in each patient into one of six groups. Of 71 patients with negative imaging before treatment, 82% had normal alkaline phosphatase levels and 83% had normal acid phosphatase levels. Of 56 patients with bone metastases at presentation, false negative alkaline and acid phosphatase levels were noted in 18% and 36% respectively, though a few patients eventually developed abnormal levels. Serial plasma biochemistry and particularly alkaline phosphatase showed a response to treatment which was not always obvious on imaging. An assessment of the hepatic component of alkaline phosphatase by reference to plasma gamma glutamyl transpeptidase and isoenzyme electrophoresis was helpful in the evaluation of a false positive result but unnecessary where imaging was positive and phosphatase elevated. It is concluded that serial alkaline phosphatase estimation is essential in the follow-up of patients with prostatic cancer and bone metastases, and probably renders serial imaging studies superfluous once the presence of skeletal metastases has been proven. By comparison, acid phosphatase is a much less effective marker.

Acid Phosphatase↗
PubMed1985

Diuresis and renal functional recovery in chronic retention.

Fifty-five patients with chronic urinary retention and incipient or actual renal failure were studied. In the majority of patients renal function improved after bladder decompression, irrespective of whether or not a diuresis occurred. Excessive loss of salt and water was rarely a matter of concern and most patients did not require intravenous fluid replacement. Several lost weight and experienced a fall in blood pressure during the period of diuresis without adverse effect upon renal functional recovery. A profound fall in blood pressure occurred in only three patients, all of whom required long-term sodium supplementation. It is concluded that the problem of salt and water loss after bladder decompression in patients with renal failure is exaggerated and difficult to predict. Over-enthusiastic replacement of fluid in strict accordance with output could readily lead to fluid overload and prolongation of the diuretic period. Therefore fluid replacement should be determined by the clinical condition of the patient and measurement of improving renal function with less emphasis on urine output and its electrolyte content.

Aged↗
PubMed1984

Carcinoma of the prostate of ductal origin.

Thirty-nine patients with ductal prostatic carcinoma have been reviewed. Their mode of presentation, initial stage, plasma phosphatase levels and response to hormone therapy were found to be similar to those in a group of 124 patients with the common acinar prostatic cancer. Histochemical examination demonstrated prostate-specific antigen in all ductal carcinomas.

Aged↗
PubMed1984

Nesbit's operation for Peyronie's disease.

Nineteen patients with Peyronie's disease were treated by a modification of Nesbit's operation. The deformity was completely corrected in 18 patients. Potency was restored to 4 of the 6 impotent patients and satisfactory coitus became possible for 15 patients, whereas it had been possible for only 3 before operation.

Adult↗
PubMed1984

Scanning electron microscopy of human bladder mucosa in acute and chronic urinary tract infection.

The morphological response of the bladder surface to acute and chronic urinary tract infection (UTI) was investigated using both scanning and transmission electron microscopy of bladder biopsies taken during routine cystoscopy. Acute bacterial infection only minimally altered bladder epithelium, whereas in chronic infections the surface layers showed gross changes which included loss of the outer layers of epithelial cells and alteration of the bladder contour. In addition, more erythrocytes and polymorphonucleocytes were present in chronic infection. In both acute and chronic urinary infection, bacteria were confined to a limited number of sites on the bladder surface and appeared to be arranged in microcolonies, but more bacteria were attached to bladder surfaces in chronic than in acute UTI. These findings were confirmed by studying epithelial cells shed from patients with proven urinary infections. A few patients who had been treated with antibiotics before cystoscopy and biopsy were also studied. These antibiotics included cephalosporins which had been previously shown to produce bacterial morphological variations in vitro. Some of these changes were subsequently observed in the biopsies and the results suggest mechanisms whereby bacteria involved in urinary tract infection can survive exposure to antibiotics.

Acute Disease↗
PubMed1983

The specific red cell adherence test in transitional cell carcinoma of the bladder before and after radiotherapy in patients with blood group A.

Serial formalin-fixed specimens of bladder tumors before and after irradiation from 19 patients with blood group A were tested for the presence or absence of antigen by the specific red cell adherence test. All patients had at least grade B transitional cell cancer of the bladder. The specific red cell adherence test was negative before radiotherapy in 9 patients, 4 of whom (44 per cent) had positive tests after treatment. However, the test was positive before radiotherapy in 10 patients (56 per cent) and became negative after radiotherapy in only 1. Of the patients 47 per cent had tumors that were positive for specific red cell adherence before and after radiotherapy, and 26 per cent had tumors that were consistently negative for antigen.

ABO Blood-Group System↗
PubMed1983

How to fill silicone catheter balloon.

The self-retaining balloons of the silicone catheters (Dover and Travenol) will lose fluid according to the concentration of the solutions injected. The process is temperature-dependent and must be governed by a balance between hydrostatic and osmotic pressure gradients. Where loss of fluid from a low-volume balloon may be critical in the premature loss of an indwelling silicone catheter, we recommend that a concentration equivalent to 5 per cent saline be used in the balloon.

Catheters, Indwelling↗
PubMed1982

Computed tomography in staging of carcinoma of the urinary bladder.

Seventy-seven patients with carcinoma of the urinary bladder were investigated by computed tomography (CT) and the results compared with those of pathological staging. The overall accuracy rate was 81% for the estimation of local tumour extension. Perivesical tumour extension was overestimated by CT owing to previous bladder surgery or radiotherapy in about half of the cases. Nevertheless, CT gives unrivalled diagnostic information in advanced tumour invasion. The diagnostic accuracy rate of CT in the detection of lymph node metastases was 89%, compared with 73% for lymphography.

Adult↗
PubMed1981

Arterial and pedicle occlusion in the hypothermic pig kidney.

Previous laboratory investigation has indicated that during induction of ischaemia the renal artery should be occluded in preference to the whole pedicle. However, in clinical practice the distinction between these may have only a trivial bearing on subsequent renal function compared with the effect of surgery on the parenchyma. The present work was designed to investigate the effects of pedicle and arterial occlusion on the pig kidney after 90 min of hypothermic ischaemia. However, 2 other groups having nephrotomy were also included to give the study more clinical relevance. The results showed that the combination of nephrotomy and pedicle occlusion gave a significant rise in plasma creatinine in the first 48 h post-operatively compared with the other groups. However, there was no difference between the 4 groups after 8 days and 28 days. Histology of the kidneys removed after 28 days showed comparatively minor changes in terms of glomerular and tubular structural abnormality. Furthermore the vasculature was well preserved though an inflammatory infiltrate was usually found. Semi-quantitative analysis of these changes showed that, paradoxically, they were generally less severe with pedicle than arterial occlusion. Another surprising result of this analysis was that the addition of nephrotomy appeared to be beneficial.

Animals↗
PubMed1981

Effectiveness of prolonged hydrostatic dilatation of bladder.

Thirty-three patients with intractable frequency and 9 patients with hematuria from irradiation cystitis, bladder tumors or both underwent 54 prolonged hydrostatic dilatations of the bladder. Thirty-eitht per cent of patients with frequency had long-lasting improvement and 19 per cent had temporary relief. Eight patients in this group had multiple procedures, having improved temporarily after previous treatments. Six of the 9 patients with hematuria had appreciable palliative relief.

Adolescent↗
PubMed1981

Sensory level and renal prognosis in myelomeningocele.

Two hundred and fourteen cases of spinal dysraphism were studied to investigate the relationship of sensory level and renal damage. It was found that in 72 cases with a high sensory level of T12 and above, 45 cases (62%) had renal damage which was the cause of death in 12; in 142 cases with a low sensory level of L1 and below, 40 cases (28%) had renal damage which was the cause of death in only 2. A palpable bladder and reflux were associated with renal damage in the cases with a low sensory level but some additional factor appears to operate in those with a high sensory level. Other reasons for the poor prognosis in these cases are discussed. The critical level in the spinal cord at which the prognosis for renal damage sharply changes coincides with the sympathetic outflow to the renal tract (T12-L1). Disruption of the spinal cord at or above the renal outflow may be a determining factor in prognosis.

Adolescent↗