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Biomedical subjects

C G Fowler

Publications and source records attributed to C G Fowler.

At least 19 recordsLinked to original sources
PubMed1992

Functional assessment of the sympathetic innervation of the microcirculation of the lower urinary tract: a preliminary report.

This paper presents preliminary data on a new method for testing the sympathetic innervation of the urothelium. A flexible laser Doppler probe was introduced into the urethra of two females and two male subjects. The percentage fall in laser Doppler flux following generalized sympathetic stimulation by taking an inspiratory gasp was measured. This resulted in 36%, 32%, 68% and 34% mean drop in urothelial blood flux. In the female subjects, the probe was advanced into the bladder and the procedure repeated, and the gasp resulted in 60% and 83% drop in flux. With laser Doppler fluxmetry, fall in microcirculatory blood flow associated with a generalized increase in sympathetic tone, therefore can be demonstrated. This method may be useful in the assessment of the integrity of the sympathetic innervation of the urothelium in patients with suspected autonomic dysfunction of the genitourinary tract.

Adult↗
PubMed1992

Effects of stimulus phase on the normal auditory brainstem response.

The purpose of this investigation was to determine the effects of stimulus phase on the latencies and morphology of the auditory brainstem response (ABR) of normal-hearing subjects. Although click stimuli produced equivalent ABR latencies for the rarefaction and condensation phases, the subtraction of the waveforms from the two phases yielded a difference potential. Tone pip stimuli produced polarity differences that were inversely related to stimulus frequency: the higher the frequency, the smaller the ABR latency differences between responses to rarefaction and condensation stimuli, and the smaller the difference potentials. Thus, whereas the latency of click-evoked ABR is dominated by high-frequency responses with equivalent latencies regardless of stimulus phase, low-frequency responses contribute to the overall morphology of the ABR that yields the phasic difference potential. The implications of these findings are discussed with reference to subjects with high-frequency hearing losses.

Acoustic Stimulation↗
PubMed1992

The late auditory evoked potential masking-level difference as a function of noise level.

The purpose of this study was to determine whether the masking-level difference (MLD) obtained with the late (P2) auditory evoked potentials has characteristics similar to those reported for the behavioral MLD with respect to the effects of noise level. Psychoacoustic studies have shown that the magnitude of the MLD increases as a function of the noise level. In the present study, P2 thresholds were measured in SoNo (signals and noise in phase at the ears) and S pi No (signals out of phase and noise in phase at the ears) conditions for noise levels of 0-60 dB pressure spectrum level (Lps). Subjects were 5 normal-hearing young adults. The difference in SoNo and S pi No thresholds, or the MLD, increased linearly as the noise levels increased through 60 dB Lps, whereas the behavioral MLD magnitude is reported to saturate at high noise levels. These results suggest that the late-potential MLD reflects characteristics similar to, but not identical with, those of the behavioral MLD.

Adult↗
PubMed1992

Ethics, logistics and a trial of transurethral versus open prostatectomy.

An increased long-term morbidity rate after transurethral compared with open prostatectomy has recently been claimed on the basis of retrospective studies of operations done up to 20 years ago. These studies have led to a demand for a prospective trial. Most reports show that peri-operative mortality following prostatectomy is virtually confined to unfit men over 80 years old. Before agreeing to participate in a trial we examined our operative mortality in this group of patients. Between 1981 and 1987, 123 octogenarians underwent transurethral prostatectomy: 64 operations were elective and 59 were performed for retention. There were 2 operative deaths (1.6%), both from gram-negative septicaemia despite prophylactic antibiotics. There were no additional deaths in the first 12 months following surgery. Few of these patients would have been considered fit to undergo an open prostatectomy. Any proposed randomised trial would have to exclude such high risk patients until it can be shown that open prostatectomy is equally safe.

Aged↗
PubMed1992

Long-term results of treatment of urethral injuries in males caused by external trauma.

Of 134 males with traumatic rupture of the urethra seen between 1967 and 1989, 10 have been lost to follow-up and 124 have been followed up for 1 to 22 years (mean 8); 100 patients had a pelvic fracture (3 with associated rectal injury) and 24 had perineal injuries. Prior to referral 31 patients (25%) had undergone treatment in addition to suprapubic cystostomy. Wherever possible, strictures were managed by optical urethrotomy (33) or intermittent dilatation (4). In 2 patients only a suprapubic cystostomy was possible. Skin inlay urethroplasty in 1 or 2 stages was performed in 75 cases, an end-to-end anastomosis with or without resection of the symphysis pubis in 7 and a scrotal tube pull-through in 3. The immediate and long-term results depended on the severity of the original injury. With minimal displacement the management was simple and the long-term prognosis good, a single urethrotomy being sufficient in 22 patients. Where there was considerable displacement the initial management was more difficult and there was a high incidence of long-term complications: of 73 patients treated by urethroplasty or end-to-end anastomosis, significant post-operative infection occurred in 11 (15%) and restenosis in 15 (20%), of whom 7 required a revision urethroplasty. Data in respect of potency were recorded in 80 patients: 28 of these were impotent, 20 of the 28 having sustained an injury with considerable displacement.

Adolescent↗
PubMed1992

Botulinum toxin in the treatment of chronic urinary retention in women.

Six women were identified as having difficulty in voiding or complete urinary retention due to abnormal myotonic-like electromyographic (EMG) activity in the striated muscle of the urethral sphincter. An attempt was made to improve voiding by injection of botulinum toxin into the striated sphincter muscle. Although 3 patients then developed transient stress incontinence, demonstrating that sufficient botulinum toxin had been given to cause sphincter weakness, no patient had significant symptomatic benefit.

Adult↗
PubMed1992

Transurethral resection syndrome. A prospective study.

Significant hyponatraemia has been reported following transurethral prostatectomy (TURP) in 11-41% of cases. The majority of previous studies have been performed retrospectively. A prospective study was undertaken of 100 patients undergoing TURP. In all, a 24-Charr sheath with non-irrigating, resectoscope and 1.5% glycine as irrigant was used. Volume of irrigant used, weight of prostate and length of procedure were recorded. Serum electrolytes were measured at anaesthetic induction and immediately on transfer to the recovery room. In none of the 100 patients was there a statistically significant fall in serum sodium following resection. No clinical changes of transurethral resection (TUR) syndrome occurred. This study confirms that TUR syndrome and a significant fall in serum sodium can be virtually prevented in TURP and the use of an irrigating resectoscope or a trocar in the average case is not necessary.

Aged↗
PubMed1992

Effects of cochlear hearing loss on the ABR latencies to clicks and 1000 Hz tone pips.

High-frequency hearing losses can substantially confound the interpretation of click-evoked auditory brainstem responses (ABRs). One method proposed to circumvent the problem is to use frequency-specific tone pips to stimulate equivalent areas on the basilar membrane in normal and pathologic groups, or in both ears of asymmetrically impaired patients. This retrospective study investigated the ABRs to clicks and 1000-Hz tone pips from 90 asymmetrically impaired subjects with cochlear pathology. The 4000 Hz threshold significantly affected the wave V latencies from both clicks and tone pips for the most severely impaired subjects. The wave V latencies were highly correlated between ears for both stimuli, but the correlation was higher with the 1000-Hz tone pips. It was concluded that the use of 1000-Hz tone pips can supplement the interpretation of click-evoked ABRs, particularly in patients whose 2000- and/or 4000-Hz thresholds are worse than 75 dB HL.

Acoustic Stimulation↗
PubMed1992

The quality of life after radical radiotherapy for bladder cancer.

The quality of life in 72 patients who had shown a complete response to radiotherapy, using a modified bladder symptom score and the Nottingham health profile, was compared with the quality of life in a similar control group matched for age and sex. There was no significant difference in either group. The records of 69 patients who had undergone post-radiation salvage cystectomy were reviewed, looking specifically at surgical complications. There were 3 post-operative deaths (5%), 3 pulmonary emboli and 3 fistulae--with some overlap of complications. Five patients who underwent cystectomy for intractable symptoms in the apparent absence of recurrent tumour were found to have residual cancer in the excised specimens.

Adult↗
PubMed1992

Relationship of pure-tone averages to speech reception threshold for male and female speakers.

The availability of a compact disc with a female speaker for clinical use has raised the issue of the equivalence between the female speaker and the previous standard male speaker for assessing the speech reception threshold (SRT). This study evaluated the relationship of two- and three-frequency averages to the SRT for a male speaker on an audio tape and a female speaker on a compact disc in two similar groups of clinic patients, each consisting of 215 ears. There were no significant differences between the SRTs for the two groups, suggesting that the two speakers/recordings are equivalent for clinical purposes. The SRTs from both speakers/recordings were within 6 dB of both the two- and three-frequency averages. There were no significant differences between the SRTs and the three-frequency average.

Acoustic Stimulation↗
PubMed1991

Early repair of iatrogenic injury to the ureter or bladder after gynecological surgery.

Contrary to the traditional doctrine of delayed intervention in post-hysterectomy injuries of the ureter or bladder, the policy at our department has been to operate as soon as possible after the diagnosis is made. Of 68 patients (25 with vesicovaginal fistulas and 43 with ureteral injuries) early intervention was possible in 40 (59%). Primary healing was obtained in all patients. These results suggest that there is no disadvantage in early repair.

Female↗
PubMed1991

A new treatment for endometrial cancer with gonadotrophin releasing-hormone analogue.

OBJECTIVE: To test the antitumour effect of gonadotrophin releasing-hormone (GnRH) analogues in women with recurrent endometrial cancer. DESIGN: An open phase II observational trial of GnRH analogues. Serial measurements of gonadotrophins, sex hormones and tumour dimensions were made together with repeat biopsy when possible to assess the response to treatment. SETTING: The outpatient clinics of the Department of Medical Oncology at The Royal London, Royal Marsden and St Bartholomew's hospitals. SUBJECTS: 17 patients with endometrial cancer which had recurred after surgery, radiotherapy and progesterone treatment and was symptomatic, progressive and assessable for response. INTERVENTION: Monthly subcutaneous injection of GnRH analogue. MAIN OUTCOME MEASURES: Reduction in serum gonadotrophins and reduction in tumour dimensions. RESULTS: Six out of 17 patients (35%, 95% CI 12.6-58%) achieved a complete or partial remission which continues for a median of 20 months with no adverse effects. CONCLUSION: GnRH analogues have a significant antitumour effect in recurrent endometrial cancer which warrants further examination in comparison with progestogens.

Adenocarcinoma↗
PubMed1990

Surgical alternatives to hysterectomy for intractable menorrhagia.

When conservative measures fail to control menorrhagia, most women have been offered hysterectomy. Endoscopic endometrial ablation presents a less radical alternative which appears to have significant advantages in patient acceptance and reduced hospital stay. The long-term outcome of these techniques remains uncertain.

Endometrium↗
PubMed1989

The bifrequency binaural interaction component of the auditory brainstem response.

The binaural interaction component of the auditory brainstem response was investigated in three stimulus conditions, 1000-Hz tone pips to both ears, 3000-Hz tone pips to both ears, and 1000-Hz tone pips to the left ear and 3000-Hz tone pips to the right ear. A binaural interaction component was produced in all conditions in which the stimuli were presented in quiet and in broadband noise, suggesting that a frequency separation of 2000 Hz between ears can produce a fused image. Responses to the bifrequency stimuli in noise indicated the peak A of the binaural interaction component is not dependent solely on the slope of wave V because when the noise caused a dissociated binaural wave V, peak A was associated only with the trailing wave V.

Acoustic Stimulation↗
PubMed1989

Transitional cell carcinoma of the renal pelvis and ureter.

In a retrospective study of 185 patients with transitional cell carcinoma of the renal pelvis and ureter, of whom 127 were treated by total nephroureterectomy and 58 by conservative resection, the survival of those with superficial well differentiated tumours was greater than 90% in each group. When urothelium was left behind after conservative resection, there was a 22% rate of recurrence on the same side but this almost only occurred when the original tumour had been multifocal. Post-operative radiotherapy did not improve survival.

Adult↗