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Biomedical subjects

P M Weston

Publications and source records attributed to P M Weston.

At least 19 recordsLinked to original sources
PubMed2001

Corporal plication for penile curvature caused by Peyronie's disease: the patients' perspective.

OBJECTIVE: To determine the acceptability by patients of corporal plication for Peyronie's disease. PATIENTS AND METHODS: A postal questionnaire was sent to 69 patients who had undergone corporal plication for Peyronie's disease between 1992 and 1999, to ascertain the subjective outcome and acceptance by the patients and their sexual partners of the results of the procedure. Of the 65 patients who were still alive, 44 (68%) returned the questionnaire. RESULTS: The mean (range) follow-up was 4.1 (0.5-7.25) years and the mean age of the patients 54.6 (32-80) years. Of the 44 patients responding, 24 (55%) were sexually active; after surgery, 16 (36%) had significant impairment of erections, seven (16%) continued to have significant penile discomfort and 15 (34%) could feel nodules at the suture site. Twenty-five (57%) patients reported a mild and six (14%) a severe persistent penile deformity; 40 (90%) reported having a shorter penis, of whom 22 (55%) thought it significant. Overall, 14 (32%) reported 'numbness' of the glans penis. Only 23 (52%) of the patients would recommend the surgery, with 25 (57%) reporting a deterioration in their overall quality of life. Of the partners of the evaluable patients, 38 (86%) responded, and a significant deterioration in sexual performance was reported by 19 (35%). CONCLUSIONS: Overall, the long-term results of corporal plication appear to be disappointing. These poor results could be related to a current lack of understanding of the natural history and progression of the disease, to case selection, or to the surgery. We intend to use these results to counsel our patients before such surgery and inform them of the possible outcome in the long term.

Adult↗
PubMed1993

Micronutrients in gastrointestinal cancer.

The monitoring of micronutrients and the relationship between dietary intake and micronutrient status prior to and after surgery in patients with histologically proven gastrointestinal adenocarcinoma, both weight-stable and weight-losing (> 7.5% of their pre-illness weight) has been studied and the results compared to controls. Plasma vitamin C and red blood cell thiamine levels were significantly lower in weight-losing cancer patients when compared to their weight-stable counterparts (P < 0.05 and P < 0.02 respectively). Weight-losing patients had a lower vitamin C (P < 0.05) and thiamine (P < 0.002) intake, and a higher elevation in plasma C-reactive protein and a lower prealbumin level (P < 0.02), when compared to both weight-stable cancer patients and controls. Plasma vitamin C, prealbumin and C-reactive protein levels remained unchanged after curative resections of the tumours compared to a preoperative value, and there was a highly significant correlation between plasma vitamin C and dietary intake of vitamin C. This study suggests that the lower vitamin C and thiamine status in weight-losing gastrointestinal cancer patients prior to surgery is due to a lower micronutrient intake and an acute phase response to their illness. Dietary intake of vitamin C appears to be the major factor in determining plasma vitamin C concentration following curative surgical resection.

Adenocarcinoma↗
PubMed1993

Familial transitional cell carcinoma and the Lynch syndrome II.

A family is presented in which 4 male siblings developed transitional cell carcinoma (TCC). Four upper tract tumours occurred in 3 and in the fourth the tumour was intravesical. Two of these patients also had colorectal adenocarcinoma. There were 2 other relatives in the pedigree with large bowel cancer. It is suggested that this is an example of Lynch Syndrome II, a hereditary non-polyposis colorectal cancer with extracolonic cancer sites. The implications regarding the screening, surveillance and detection of possible carrier status in healthy relatives is discussed.

Adult↗
PubMed1991

Artificial urinary sphincters around intestinal segments--are they safe?

Artificial urinary sphincters (AUS) were implanted around intestinal segments to achieve urinary continence in 8 patients and faecal continence in 1. In 6 patients the cuff was placed around the lower end of the cystoplasty following bladder neck (5) or urethral (1) erosion. Four are completely dry, 1 on self-intermittent catheterisation (SIC). One has mild stress incontinence. In 1 patient the cuff eroded at 8 months. Two patients had cuffs implanted parastomally to create continent diversion. One is satisfactory on SIC and the other had her AUS explanted because of life-threatening metabolic acidosis. The rectal cuff was explanted because of faecal impaction above the cuff. As an absolute last resort, placing an AUS round a cystoplasty appears little more hazardous than round bladder neck. The use of the AUS for continent diversion has not been pursued because of reliable techniques of non-prosthetic continent diversion. The current model of the AUS is unsuitable for the treatment of faecal incontinence.

Adolescent↗
PubMed1990

Assessment of the poorly contractile or acontractile bladder in the older male in the absence of neuropathy.

Up to 30% of patients who undergo prostatectomy are left with residual symptoms. Most have persistent detrusor instability, but some have poorly contractile or acontractile bladders. Over a 2-year period, 42 neurologically normal patients were shown to have a hypocontractile or acontractile bladder on urodynamic testing; 27 had undergone outflow tract surgery. Four patients who were totally incontinent had undergone at least 2 transurethral resections. The remainder had severe frequency, urgency and nocturia. Urodynamically, all but 7 patients with poor compliance had normal filling cystometrograms, all but 8 had residual urine volumes less than 100 ml, and 26 had less than 5 ml. Thus their symptoms are difficult to explain. Apart from the insertion of an artificial sphincter in those with total incontinence, treatment did not improve any of these patients.

Adult↗
PubMed1990

The "clam": indications and complications.

We have reviewed 78 patients who underwent "clam" enterocystoplasty as part or all of their lower urinary tract reconstruction. Nearly half (32) were non-neuropathic; the remainder were either overtly neuropathic (mainly spina bifida) or suspected neuropathic (mainly the older primary enuretics). Only 5 were non-walkers--all neuropathic. Most patients were operated on for incontinence but 12 had upper tract damage related either to urinary diversion or to poor bladder compliance in the early phase of filling; 69 patients became dry, voiding spontaneously (30), by activation of an artificial urinary sphincter (17) or by self intermittent catheterisation (22). Four patients still have nocturnal enuresis, 3 diurnal enuresis and 2 have stress incontinence. One patient has had a continent diversion. The "clam" procedure has revolutionised bladder reconstruction. Careful review has failed to predict the small number who do not achieve a perfect result.

Adolescent↗
PubMed1989

Diet-induced thermogenesis in patients with gastrointestinal cancer cachexia.

1. Indirect calorimetry has been used to measure resting energy expenditure (REE) and the thermogenic response to a test meal (diet-induced thermogenesis) in groups of weight-stable and weight-losing patients with gastrointestinal adenocarcinoma. Average daily intakes of energy and protein were computed from dietary assessment for the week before hospitalization. Results were compared with a control group of patients with benign gastrointestinal disease. 2. Weight-losing cancer patients had a significantly reduced mean total energy and protein intake. 3. There was no significant difference in REE between the groups when results were normalized in terms of metabolic body size (kJ/kg 0.75) and lean body mass (kJ/kg). 4. Diet-induced thermogenesis was reduced in weight-losing cancer patients. 5. It is suggested that the reduction of diet-induced thermogenesis in weight-losing cancer patients is another element of starvation adaptation, subsequent to their weight loss, and that altered thermogenesis does not contribute to the weight loss seen in cancer cachexia.

Adenocarcinoma↗
PubMed1989

Poor compliance early in filling in the neuropathic bladder.

A total of 30 patients with known neuropathy, mostly spina bifida, developed poor bladder compliance early in filling demonstrated urodynamically; 20 had bilateral hydronephrosis at the time of presentation and 5 also had severely impaired renal function. After appropriate treatment all of those with normal upper tracts or with bilateral hydronephrosis but normal renal function stabilised or improved. However, all 5 with severely impaired renal function progressed to end-stage renal failure. Poor compliance early in filling is an absolute indication for surgical intervention.

Adolescent↗
PubMed1987

Colonoscopy or barium enema as initial investigation of colonic disease.

To determine whether double-contrast barium enema (DCBE) or fibreoptic examination should be the first-line investigation for colonic disease 76 consecutive patients presenting for the first time to the outpatient clinic with symptoms of colonic disease deemed to need a DCBE after negative rigid sigmoidoscopy were entered into a trial. All underwent flexible sigmoidoscopy, then DCBE, and finally colonoscopy. 66 patients completed the study. DCBE alone gave the final diagnosis in 42 (67%) and colonoscopy alone in 60 (91%) (p = 0.0004). A combination of flexible sigmoidoscopy and DCBE led to the diagnosis in 50 patients (76%). With DCBE alone 73% of polyps and 64% of patients with inflammatory bowel disease were missed. No complications arose from the investigations. 32 (48%) patients found DCBE distressing and 15 (23%) found colonoscopy uncomfortable (p = 0.004). Its high diagnostic accuracy and relative lack of discomfort for patients make colonoscopy the primary procedure for investigating patients with large bowel symptoms referred to the general surgeon.

Adult↗
PubMed1987

Care of the injured in the Third World--what can we learn?

There is a need to put more emphasis on primary surgical care centred on provincial and district hospitals in the developing world using simple equipment which needs little maintenance and low running costs. The general duty doctors and paramedicals who are at the first point of contact with the patient, need practical on-site instruction in dealing with common surgical emergencies, of which injury forms a large part. To achieve this change in emphasis, provision should be made for surgical trainees and experienced surgeons from the United Kingdom or else where to work in selected provincial and district hospitals where support services can be adequately provided. The experience they would gain, would in turn benefit their patients in the National Health Service. If this activity is to have any chance of success, the training and research potential must be recognized by the Royal Colleges as valid experience in higher surgical training programmes. The National Health Service and the Health Authorities must accept these periods overseas as integral parts of a career in the National Health Service. This would include provision for superannuation, encouraging proleptic appointments to consultant posts, and secondment or early retirement of Consultants. Funding should be sought from international and national agencies for a pilot project based on a direct link between a district hospital in this country and a selected district or provincial hospital in a developing country.(ABSTRACT TRUNCATED AT 250 WORDS)

Africa, Eastern↗