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Biomedical subjects

C C Carson

Publications and source records attributed to C C Carson.

At least 37 records · Page 2Linked to original sources
PubMed1999

Management of prosthesis infections in urologic surgery.

Prosthetic devices are a cornerstone of urologic surgical care. The most disastrous complication of these surgical procedures is infection. The prevention, identification, and management of infections are critical to maintaining functional urologic prosthetic devices. Although the incidence is low, rapid identification of infections once they occur and proper management with antibiotics, surgical intervention, irrigation, and salvage procedures can maintain the function of urologic prosthetic devices despite clinical infection.

Antibiotic Prophylaxis↗
PubMed1999

Fournier's disease.

Fournier's gangrene is an aggressive synergistic fasciitis of the perineum. The disease can no longer be considered to be idiopathic; in most cases a urologic, colorectal, or cutaneous source can be identified. Despite antibiotics and aggressive debridement, the mortality rate remains high, particularly in the elderly, in patients with renal failure, and in patients with extensive disease. The presentation is highly variable, necessitating a high index of suspicion. High-risk patients include diabetics, alcoholics, and debilitated and immunosuppressed individuals. As the AIDS population increases, the incidence of Fournier's gangrene may increase as well. In questionable cases, imaging modalities should be performed to allow early diagnosis and to reduce missed diagnoses. Broad-spectrum antibiotics and aggressive debridement remain the hallmarks of treatment. Hyperbaric oxygen therapy and improved local wound care may decrease the extent of tissue destruction. Reconstructive techniques afford better cosmetic results. With early recognition, prompt treatment, improved wound care, and reconstructive efforts, the mortality rates and cosmetic results should continue to improve.

Diagnosis, Differential↗
PubMed1999

The epidemiology, anatomy, physiology, and treatment of erectile dysfunction in chronic renal failure patients.

Erectile dysfunction (ED) is an associated morbidity for men with chronic renal failure. An understanding of the epidemiology, anatomy, physiology, and treatment options for ED can greatly improve the quality of life for men with chronic renal failure. There are psychological and physiological causes for erectile dysfunction. Once the key features leading to the patient's loss of potency have been identified, appropriate treatment plans can be instituted, often with successful outcomes. The purpose of this article is to assist the nephrology interdisciplinary team in the management of ED by reviewing possible causes, available studies, and treatment options for their patients.

Erectile Dysfunction↗
PubMed1999

Reconstructive surgery using urological prostheses.

Urological prostheses have been available and widely used for the past two decades. The use of penile prostheses, artificial urinary sphincters, and testicular implants for genitourinary reconstruction for erectile dysfunction, incontinence, and orchiectomy have been successful, widely used and of low morbidity. More recently designed devices, innovations in implantation techniques, and improved intraoperative and postoperative care have resulted in the successful worldwide use of these prosthetic devices.

Female↗
PubMed1998

Unusual complications of the vacuum erection device.

OBJECTIVES: The vacuum erection device (VED) is usually well tolerated and very effective for patients with erectile dysfunction. When used correctly, VEDs carry low morbidity and few recognized complications. We report on 5 patients who developed unusual complications associated with VED use, including two previously unreported complications of urethral bleeding and capture of scrotal tunica within the penile shaft. METHODS: Patient 1: a 38-year-old diabetic man with significant peripheral neuropathy and an 8-year history of erectile dysfunction developed penile skin necrosis at the ring site after leaving the penile ring on for an excessive length of time (6 hours). Patient 2: a 76-year-old diabetic man who used a VED correctly for 3 months developed severe urethral bleeding. Patient 3: a 75-year-old diabetic man who enjoyed satisfactory erections with a VED for 14 months developed a 3 x 3-cm penile cystic mass located on the proximal right side of the penile shaft. This mass was not present in the flaccid state and was seen only with VED use. Patient 4: a 65-year-old man developed Peyronie's disease after 4 years of correct VED use. Patient 5: a 62-year-old man with neurogenic impotence following a radical prostatectomy developed penile ecchymoses acutely following placement of a smaller constriction ring. He subsequently developed a dorsal penile plaque with mild dorsal curvature. RESULTS: Patient 1 did well with local skin care and no longer uses a VED. Patient 2 underwent cystoscopy and was found to have prominent urethral vessels (varicosities) in the midurethra, compared with a normal cystoscopy 9 months previously. This patient no longer uses a VED and now denies any urethral bleeding at 15-month follow-up. Patient 3 underwent corpora cavernosography and contrast injection of the cystic mass. These radiographic studies showed that the mass did not communicate with either corpora cavernosa or the corpus spongiosum. A retrograde urethrogram failed to show a urethral diverticulum. The patient was surgically explored, and the penile cystic mass was found to be scrotal tunica vaginalis. Subsequently, a hydrocele repair was performed, yet postoperatively the patient developed testicular migration into the ipsilateral penile shaft. Testicular fixation was not feasible secondary to a childhood herniorrhaphy, and an orchiectomy was performed. Patient 4 underwent implantation of a penile prosthesis and is doing well at 3-year follow-up. Patient 5 experiences mild dorsal penile curvature with erections induced by transurethral prostaglandin E1. The penile curvature does not interfere with intercourse and will be managed conservatively. CONCLUSIONS: We describe unusual side effects associated with VEDs. Although thousands of men use VEDs successfully and without morbidity, the urologist must be aware of unusual complications associated with VED use.

Adult↗
PubMed1998

Cardiac arrhythmias with external fixed-rate signal generators in shock wave lithotripsy with the Medstone lithotripter.

OBJECTIVES: To evaluate the incidence and outcome of cardiac arrhythmias associated with an external fixed-rate generator and the Medstone lithotripter with regard to stone location, anesthesia type, patient age, and gender. METHODS: Data were obtained on 933 patients who underwent shock wave lithotripsy (SWL) with the Medstone lithotripter. Patients were randomly divided into two study groups, including those with pre-existing cardiac disease, hypertension, and cardiac medications. Group 1 (576 patients) were treated with the external fixed-rate signal generator (cardiac simulator). Group 2 (357 patients) underwent electrocardiogram-gated SWL (no simulator). All patients were monitored for arrhythmias during SWL. Patients who developed arrhythmias on the simulator were converted to gated SWL. RESULTS: In group 1, 463 patients (80%) had no arrhythmias during treatment, whereas 113 patients (20%) developed cardiac arrhythmias (primarily premature ventricular contractions [PVCs]) and were successfully converted to gated SWL. Only 1 patient in group 2 (0.3%) had a documented arrhythmia (PVC). Group 1 patients who developed arrhythmias with a cardiac simulator were more likely to have renal rather than ureteral stones. Chi-square analysis showed a significant correlation between patients with and without arrhythmias in group 1 with regard to stone location (P <0.0001). In group 1, regional anesthesia, intravenous anesthesia, and general anesthesia had an arrhythmia rate of 14%, 27%, and 38%, respectively. The only patient in group 2 who developed arrhythmias was under general anesthesia. The differences between groups 1 and 2, with regard to anesthesia type and arrhythmia, were statistically significant (P <0.001). No patients required additional medical therapy or hospitalization for cardiac events, and all patients safely completed the SWL treatment. CONCLUSIONS: With careful monitoring and adequate precautions, external fixed-rate signal generators are safe, effective methods for pacing the Medstone shock wave lithotripter and probably other extracorporeal shock wave lithotripters.

Arrhythmias, Cardiac↗
PubMed1998

Penile prosthesis implantation in the treatment of Peyronie's disease.

PURPOSE: This study was undertaken to evaluate the results and complications of penile prosthesis implantation in patients with erectile dysfunction caused by Peyronie's disease. MATERIALS AND METHODS: Men undergoing surgical intervention for erectile dysfunction caused by Peyronie's disease at the University of North Carolina School of Medicine were reviewed. Patients included 30 men aged 29-64 (mean = 49.6) with a duration of Peyronie's disease from 12-72 months (mean = 31.4 months). All men had palpable Peyronie's plague, significant penile curvature and plaque formation. All patients underwent implantation of AMS 700CX penile prostheses from 1993 to 1997. RESULTS: Penile straightening was carried out using modeling in 28 (93%) while plaque incision was necessary in 2 men (7%). All patients had a resultant straight penis with functional penile implant. There were no patients who suffered penile prosthesis infection and no mechanical malfunctions were observed during the follow-up. CONCLUSIONS: Penile prosthesis implantation with modeling is a safe, simple, effective technique for straightening penile curvature in patients undergoing implantation of penile prosthesis for Peyronie's disease. Penile prosthesis implantation is a safe, effective, low morbidity method for restoring potency in men with male erectile dysfunction and Peyronie's disease.

Adult↗
PubMed1998

Penile prosthesis implantation surgery: a statewide population based analysis of 2354 patients.

AIMS OF THE STUDY: Minimally invasive therapy for erectile dysfunction (ED) has changed the frequency of penile prosthesis surgery. The purpose of this study is to describe the changes in frequency, hospital stay, hospital charges and penile prosthesis type in North Carolina. MATERIALS AND METHODS: The data source was a statewide hospital discharge database which includes data on hospitalized patients for all 151 hospitals in North Carolina. RESULTS: From 1988-1993, 2354 patients underwent implantation of penile prostheses. The total number of penile prostheses implanted has declined over this six year period. Similarly, hospital stay has declined from an average of 4.03-2.96 d with a 46.6% decrease in total hospital days. Despite this change in hospital stay, hospital charges rose significantly from an average of $7252.48 to $12,842.18 driving total charges from $2973,516.80 to $3,826,969.60 (1993) representing a 28.7% increase. CONCLUSIONS: Minimally invasive therapy and changes in reimbursement have had a major impact on the number of patients undergoing penile prosthesis implantation for ED. This downward trend may continue as more treatment options develop from the marked increase in research in this field. However, this may result in an increase of patients seeking treatment overall.

Erectile Dysfunction↗
PubMed1998

Quantifying risk of penile prosthesis infection with elevated glycosylated hemoglobin.

PURPOSE: Elevation of glycosylated hemoglobin above levels of 11.5 mg.% has been considered a contraindication to penile prosthesis implantation in diabetic patients. We determine the predictive value of glycosylated hemoglobin A1C in penile prosthesis infections in diabetic and nondiabetic patients to confirm or deny this prevalent opinion. MATERIALS AND METHODS: We conducted a 2-year prospective study of 389 patients, including 114 diabetics, who underwent 3-piece penile prosthesis implantation. All patients had similar preoperative preparation without regard to diabetic status, control or glycosylated hemoglobin A1C level. Risk of infection was statistically analyzed for diabetics versus nondiabetics, glycosylated hemoglobin A1C values above and below 11.5 mg.%, insulin dependent versus oral medication diabetics, and fasting blood sugars above and below 180 mg.%. RESULTS: Prosthesis infections developed in 10 diabetics (8.7%) and 11 nondiabetics (4.0%). No increased infection rate was observed in diabetics with high fasting sugars or diabetics on insulin. There was no statistically significant increased infection risk with increased levels of glycosylated hemoglobin A1C among all patients or among only the diabetics. In fact, there was no meaningful difference in the median or mean level of glycosylated hemoglobin A1C in the infected and noninfected patients regardless of diabetes. CONCLUSIONS: Use of glycosylated hemoglobin A1C values to identify and exclude surgical candidates with increased risk of infections is not proved by this study. Elevation of fasting sugar or insulin dependence also does not increase risk of infection in diabetics undergoing prosthesis implantation.

Diabetes Complications↗
PubMed1998

A comparative study of the Abrams-Griffiths nomogram and the linear passive urethral resistance relation to determine bladder outlet obstruction.

PURPOSE: The Abrams-Griffiths and linear passive urethral relationship (PURR) nomograms are commonly used to diagnose bladder outlet obstruction. To the best of our knowledge there are no clinical studies comparing these 2 evaluations to determine if they similarly predict the findings of bladder outlet obstruction. MATERIALS AND METHODS: From October 1994 through December 1996 multichannel urodynamic studies were performed in 72 men with lower urinary tract symptoms. The data from each urodynamic study were plotted on the Abrams-Griffiths and PURR nomograms. RESULTS: Using the Abrams-Griffiths nomogram 23 patients (46%) were unobstructed, 15 (21%) were equivocal for obstruction and 24 patients (33%) were obstructed. When the linear PURR nomogram was applied to the pressure-flow data in each group all unobstructed cases were categorized into grade 0 or 1 (no obstruction), equivocal into grade 2 (mild obstruction) and obstructed into grades 3 through 6 (moderate to severe obstruction). CONCLUSIONS: The Abrams-Griffiths and linear PURR nomograms are helpful and comparable clinical tools to assess lower urinary tract symptoms in men. The linear PURR nomogram not only detects the presence of bladder outlet obstruction but grades its severity, which may be helpful to monitor treatment.

Aged↗
PubMed1998

Acucise endopyelotomy: a successful therapeutic intervention in the treatment of ureteropelvic junction obstruction.

Ureteropelvic junction obstruction is a well-recognized cause of pain and eventual renal failure. This condition may be congenital or it can develop secondary to renal calculi, infection, and instrumentation. Surgical intervention is the definitive therapy, and a number of surgical options are available to treat ureteropelvic junction obstruction. We describe an approach using the Acucise cutting balloon to perform retrograde endopyelotomy. In 12 patients making up 13 renal units, our success rate was 92.3%, at a mean follow-up of 8.4 months (range 2 to 21 months). Complications were minimal. Based on our experience, Acucise endopyelotomy is a successful therapeutic intervention in treating ureteropelvic junction obstruction.

Adolescent↗
PubMed1997

Peyronie's disease is associated with Paget's disease of bone.

Peyronie's disease is an idiopathic disorder in which an inflammatory fibrosis occurs in the tunica albuginea of the corpora cavernosa which causes the erect penis to become deformed. Peyronie's disease has a prevalence of 1% in men over age 50 years. Paget's disease of bone is a chronic skeletal disease with areas of increased bone turnover leading to pain, deformity, and in some cases arthritis. Because of a high rate of Peyronie's disease in subjects in a Paget's disease industry-sponsored drug trial, we asked whether there was an association between Peyronie's disease and Paget's disease of bone. We evaluated 61 men with Paget's disease attending our clinic for metabolic bone disease in a tertiary referral hospital, reviewed hospital records of all men discharged from our three hospitals with the diagnosis of Peyronie's disease, and mailed a validated questionnaire about shape of the erect penis to 1500 male members of the Paget Foundation. In the clinic population of men with Paget's disease of bone, 51 of 61 (83.6%) reported having normal erections; 10 patients (16.4%) were impotent. Sixteen of the 51 men (31.4%) had developed a bend or deformity in their erect penis which was confirmed by a urologist's examination to be Peyronie's disease. When the men with Paget's disease with and without Peyronie's disease were compared, there was no difference in their ages, years with Paget's disease, or serum alkaline phosphatase level. Upon medical record review, 1 patient of 262 (0.4%) with Peyronie's disease was found to have Paget's disease of bone. The men with Paget's disease returned their questionnaires for a response rate of 44.8% and reported Peyronie's disease with a prevalence of 14.5%. We suggest that Peyronie's disease is associated with Paget's disease of bone. Furthermore, we suggest that Peyronie's disease may be a previously unrecognized complication of Paget's disease of bone.

Aged↗
PubMed1997

Potassium para-aminobenzoate for the treatment of Peyronie's disease: is it effective?

The medical treatment of Peyronie's disease remains controversial. Oral and injectable medications have been used with little documented disease specific effectiveness. Potassium para-aminobenzoate (POTABA) has long been suggested as a treatment for the plaque, curvature, and pain produced by chronic Peyronie's disease. We report a retrospective review of 32 patients treated for at least 3 months with 12 g of POTABA powder daily and followed for 8 to 24 months. Symptom resolution demonstrated improvement in penile discomfort in 8 of 18 patients, decreased plaque size in 18 of 32 patients, and improvement in penile angulation in 18 of 31 patients. Complete resolution of angulation was reported in 8 of 31 patients. While this review was retrospective and uncontrolled, it does suggest a place for POTABA in the treatment of Peyronie's disease. In order to confirm these findings and to control for the natural history of spontaneous resolution of Peyronie's disease symptomatology, a prospective, double-blind, multicenter, well-controlled study with objective criteria should be established.

4-Aminobenzoic Acid↗
PubMed1996

Doppler sonography in the evaluation of corporovenous competence after penile vein ligation surgery.

Doppler ultrasonographic findings in patients after penile vein ligation surgery are described and compared to the results of cavernosometry and cavernosography. Peak systolic and end diastolic velocities were recorded for both cavernosal arteries at 5 min intervals after papaverine injection for a total of 30 min. Peak end diastolic flow rates were compared with cavernosometric and cavernosographic results at 0-10 min, 11-20 min, and 21-30 min. Cavernosography identified venous leakage in nine patients. The end diastolic velocities were greater than the 5 cm/s threshold level generally considered to be indicative of venous leakage in nine of the nine patients (100%) at 0-10 min, in eight of the nine (89%) at 11-20 min, and in nine of the nine (100%) at 21-30 min. Although peak end diastolic velocities at or near the 5 cm/s threshold could be found in patients both with and without recurrent venous leakage in the initial 10 min of the studies, only patients with recurrent venous leakage had diastolic velocities that exceeded the 5 cm/s level when measured 10 min or more after injection. Measurement of end diastolic velocities between 21 and 30 min after injection seemed to discriminate most effectively the patients with recurrent venous leakage from those without leakage in the postoperative population.

Adult↗
PubMed1995

Azidotetrakis(trimethylphosphine)nickel(II) tetrafluoroborate.

The title complex, [Ni(N3)(C3H9P)4]BF4, is a nearly perfect trigonal bipyramid with the azide group at an apical position. The metal-azide bond angle, Ni1--N1--N2, of 138.6(5) degrees is the largest observed for a terminal azide ligand.

Crystallography, X-Ray↗