Biomedical subjects
W G Bowsher
Publications and source records attributed to W G Bowsher.
Radiotherapy as a treatment for bladder cancer.
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Laparoscopic pelvic lymph node dissection for carcinoma of the prostate and bladder.
Improvements in instruments and camera systems have allowed the development of operative techniques for laparoscopic pelvic lymph node dissection. A series of dissections in 20 patients is reported. The mean operation time was 1 h and 40 min. When the nodes appeared malignant, a node biopsy was sent for frozen section. If this was positive, the dissection went no further. In three patients it was necessary to complete the operation by open surgery. A mean number of five lymph nodes was dissected per side. After laparoscopic dissection, all patients were discharged the morning after surgery. The operation is possible without making great demands on hospital bed occupancy and the patient has a comfortable and speedy return to normal activity. Using laparoscopic techniques, node dissection becomes a more appealing option as an investigation and staging procedure.
Radiation protection in percutaneous renal surgery.
Two British centres have published the radiation doses received during percutaneous nephrolithotomy (PCNL). Their results were disparate. This study was performed to establish the likely exposure of the eyes and fingers of an experienced urological surgeon who creates the track into the kidney and also performs the endoscopic operation. In addition, some radioprotective gloves were evaluated. Provided that specific precautions, including a judicious use of screening, are taken, the current dose limits are unlikely to be exceeded. However, a 30% reduction in the dose limits is probable. Wearing routine radiation badges under a lead apron is an inadequate method of monitoring exposure: urologists should press for more active assistance from radiation protection officers in the monitoring of procedures in theatre and the use of ultrasound should be encouraged.
Laser ablation of the prostate in patients with benign prostatic hypertrophy.
Seventeen patients with bladder neck obstruction due to benign prostatic hypertrophy have been treated with the Neodymium: YAG laser. We review our experience since the first patient was treated in September 1990. Using a prototype deflecting gold alloy tip on a quartz laser fibre (Lateralase TM), we ablated obstructing prostatic adenoma and constricting bladder neck tissue. Experience with this technique has enabled a patient population to be defined in whom laser therapy for prostatic obstruction may be effective. The treatment is relatively simple, speedy and attended by virtually no blood loss. Laser ablation therapy may offer some advantages over conventional transurethral resection of the prostate (TURP) in a selected subgroup of patients. The advent of new delivery systems may make laser ablation therapy a practical alternative to TURP.
Laparoscopic pelvic lymph node dissection.
The infiltration of pelvic lymph nodes by carcinoma of the prostate or carcinoma of the bladder is an important factor in disease staging. Until now, this could be accurately assessed only by means of open surgery, an undesirable option as an investigation. Recent advances in laparoscopic instruments and camera systems have allowed the performance of laparoscopic pelvic lymph node dissection. A series of dissections in 14 patients is reported.
Prediction of response to lithotripsy--the use of scanning electron microscopy and X-ray energy dispersive spectroscopy.
A single urine sample was obtained from each of 38 patients before and immediately after treatment with a Wolf Piezolith 2300. Each sample was analysed for crystals using scanning electron microscopy and X-ray energy dispersive spectroscopy. In all cases it was possible to make a stone diagnosis prior to treatment and there was 100% correlation between the pre- and post-treatment diagnosis. All stones smaller than 90 mm2 on plain X-ray cleared with piezoelectric lithotripsy alone, regardless of composition. Larger stones composed of calcium oxalate were all successfully fragmented, but 5 of 15 mixed or phosphate stones failed to respond.
Single urine sample diagnosis. A new concept in stone analysis.
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Clinical experience using the Wolf Piezolith device at 2 British stone centers.
Machines using the principle of piezoelectric extracorporeal shock wave lithotripsy have been developed. This has allowed the prospect of painless treatment for renal and ureteral calculi. The experience with use of 2 Wolf Piezolith machines for 1 year is presented. Different second generation lithotriptors have varying techniques of production of shock waves and different imaging methods. The Wolf Piezolith device uses ultrasound imaging and piezoelectric crystals for shock wave generation. Between June 1987 and May 1988, 545 patients 5 to 84 years old were treated with the Wolf Piezolith device. Of these patients 2-month followup data are available for 367 (398 renal units). Outpatient treatment was used routinely. For renal calculi complete fragmentation (into particles less than 2 mm. in size) was achieved in 94 per cent of the patients, with 53 per cent being completely free of stone at 2 months. For ureteral stones treated in situ the best results were obtained in the upper and lower ureter. Over-all, 62 per cent of the patients required more than 1 treatment, with the number of treatment sessions required increasing with the size of the stone treated. Morbidity was low. Ultrasound imaging has proved to be as effective as x-ray imaging. Compared to Dornier HM-3 lithotripsy, installation and running costs were low. The machine offers a favorable alternative to first generation lithotriptors.
Second generation lithotripsy: an experience of 200 patients.
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Treatment of carcinoma in a solitary kidney: alternative technique.
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Morbidity, mortality and local recurrence following regional node dissection for melanoma.
Eighty-six patients who underwent regional node dissection (RND) for melanoma were reviewed with respect to short and long term postoperative morbidity, mortality and local recurrence rate. Twenty-eight per cent of dissections were prophylactic and seventy-two per cent therapeutic. There were significant wound related complications which tended to delay hospital discharge, in particular following axillary and groin dissections, but symptomatic long term complications were infrequent. The postoperative mortality rate was 1.2 per cent. Local recurrence in RND scars was particularly common in the neck (33 per cent). RND for melanoma is a safe procedure, with significant short term but relatively little long term morbidity. Both recurrence and morbidity should be borne in mind when considering patients for prophylactic RND. Surgeons should be prepared to use axial or myocutaneous flaps where extensive skin resection is necessary. A controlled trial of prophylactic antibiotics would be useful to try to reduce the incidence of wound infection.
False aneurysm of the femoral artery: computed tomographic and ultrasound appearances.
Twenty-five patients presenting with pulsating masses in the groin, 1-10 days after diagnostic arterial catheterisation, were investigated by computed tomography (CT), ultrasound (US) or both. False aneurysm was demonstrated in 10, four by CT alone, three by US alone and three by both CT and US. Both methods allowed rapid accurate and non-invasive diagnosis of this uncommon complication of arterial catheterisation.